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<OU_1 64748 



TRAINING 

'- IN 

PSYCHIATRIC 
SOCIAL WORK 



OSMANIA UNIVERSITY LIBRARY 

Call No. 136. 76/S971 1 Accession No. 32806 

Author Swift, 5. 

Tick Training in psychiatric social work 

This book should he returned mi or before the date last marked below. 



TRAINING IN PSYCHIATRIC SOCIAL WORK 



Training in 
Psychiatric Social Work 

AT THE INSTITUTE FOR CHILD GUIDANCE 
1927-1933 

BY SARAH H. SWIFT 

FOREWORD BY LAWSON G. LOWREY, M.D. 



NEW YORK 

The Commonwealth Fund 

LONDON HUMPHREY MILFORD OXFORD UNIVERSITY PRESS 



COPYRIGHT 1934. 
BY THE COMMONWEALTH FUND 

PUBLISHED NOVEMBER, 1934 



PRINTED BY E. L. HILDRETH & COMPANY, INC., BRATTLKBORO, VERMONT 



ACKNOWLEDGMENTS 

During the 'preparation of this book. Dr. Marion E. K en- 
worthy y Dr. Lawson G. Lowrey y and Miss Christine C. Robb 
generously devoted much time to the reading of the manu- 
script. For their helpful suggestions the author is very grate- 
ful. She also wishes to acknowledge the assistance of Miss 
Lorraine Fraser, who compiled the statistical material y and 
that of Miss Mary Augusta Clark , who was kind enough to 
examine all these data and to help in their interpretation. 

S.H.S. 

September, 1934 



CONTENTS 

FOREWORD. By Lawson G. Lowrey y M.D. IX 

i. INTRODUCTION: CHANGES IN CONCEPTS OF TRAIN- 

ING IN PSYCHIATRIC SOCIAL WORK I 

II. THE TRAINING PROGRAM AT THE INSTITUTE FOR 

CHILD GUIDANCE 12 

III. UTILIZATION OF CASE MATERIAL IN TRAINING 39 

IV. GROUP CONFERENCES ON CASES: TRAINING VALUES 59 
V. SUPERVISOR AND STUDENT 7O 

VI. VOLUME AND QUALITY OF STUDENT WORK 114 

VII. EXAMPLES OF INDIVIDUAL TRAINING EXPERIENCE 



APPENDIX. ADJUSTED AVERAGES OF THE NEW YORK 

SCHOOL SPECIAL STUDY GROUP 169 

INDEX 171 



TABLES 

Table I. Distribution of time in hours and minutes of stu- 
dents from Smith College School. Averages per student per 
week for the year 1931193.2 37 

Table 2. Distribution of time in hours and minutes of three 
quarter students from New York School. Averages per stu- 
dent per week for the year 19311932 38 

Table 3. Distribution of students by length of case work ex- 
perience. Special Study Groups and all students from both 
schools 119 

Table 4. Distribution of students by age. Special Study 

Groups and all students from both schools 12 1 

Table 5. Distribution of students by length of case work ex- 
perience and by age. Smith College School Special Study 
Group 123 

Table 6. Distribution of students by length of case work ex- 
perience and by age. New York School Special Study Group 123 

Table 7. Distribution of average volume of work per student 

by experience. Smith College School Special Study Group 129 

Table 8. Distribution of average volume of work per student 

by age. New York School Special Study Group 131 

Table 9. Distribution of students by experience and by 
quality of work. Smith College School and New York 
School Special Study Groups r 36 

Table 10. Distribution of students by age and by quality of 
work. Smith College School and New York School Special 
Study Groups 137 

Table 1 1 . Distribution of average volume of work per stu- 
dent by quality of work. Smith College School Special 
Study Group 141 

Table 12. Distribution of average volume of work per stu- 
dent by quality of work. New York School Special Study 
Group 142 



FOREWORD 

IT was part of the original plan of the Institute to study 
the problems involved in field and clinical training of 
workers in child guidance. Previous to 1927, when the Insti- 
tute was founded, all too little consideration had been given 
to this subject, which is so important for the study and treat- 
ment of difficulties arising in human relationships, as exem- 
plified by the problem child and his family. In only a few 
centers had field training for social workers and clinical train- 
ing for psychologists and psychiatrists been thoughtfully 
planned and carried through. In most instances, training had 
been a matter of putting people to work, adding occasional 
criticisms, and offering opportunity for attendance at confer- 
ences and seminars. 

The Institute was planned to offer more intensive training 
experience for psychiatrists, psychologists, and social workers 
than is ordinarily possible when the primary function of an 
organization is service. It did not aim to give theoretical 
training; instead its function was to offer a coordinated, su- 
pervised practical experience in the application of theory to 
practice. The number of people to be trained (maximum in 
training at one time 54); variety of the groups psychia- 
trists, psychologists, and social workers; diversity of back- 
grounds and particular interests; variations in length of time 
spent and in schedules for the period; need for protection of 
the interests of patients; interaction of personal, family, 
school, and other problems and the need for treatment of 
such difficulties as they emerged these and other factors not 
only presented particular difficulties and challenges but espe- 
cial opportunities for the study of the various factors in- 
volved in providing the most satisfactory training to be of- 
fered in each field. 



X TRAINING IN PSYCHIATRIC SOCIAL WORK 

General plans varied for each of the three groups accord- 
ing to the qualifications required for admission to training. 
Thus all psychiatrists were already trained by postgraduate 
work in the fundamentals of psychiatry. The chief points to 
be met in their year of training experience were to provide: 
supervised work with children, a new field for practically all 
of them; additions to their technical armamentarium for ex- 
amination and treatment $ and opportunity to develop ability 
for team work, capacity to assume leadership, and compre- 
hension of the contributions to be made by other members of 
the group. 

Psychologists who came for training were competent, by 
virtue of graduate work, to handle the usual series of "men- 
tal tests." They usually lacked clinical experience in the in- 
terpretation of these tests in relation to other findings, and 
had only rarely had experience in working with other people 
professionally engaged in the study of human behavior. The 
training needs then were to amplify experience with tests, 
emphasising their interpretation and correlation with other 
findings, and to develop team work. 

With the social workers, as Miss Swift shows in detail in 
the following pages, the issues to be met were much more 
varied. The two schools of social work with which these stu- 
dents were associated operated according to different sched- 
ules for time spent in field work and used different curricula 
of classroom instruction. Furthermore, the students varied 
greatly in the extent of previous experience with case work 
in general or in specific fields. Accordingly, the problems of 
supervision were complicated not only by the needs of the 
patients, but by the needs of the students. This was naturally 
true in all divisions of Institute training, but much more so 
in social service than in the other two divisions. The larger 
number of social service students by comparison with any 



FOREWORD XI 

other group, the emphasis laid on work with the child in his 
ordinary environments, the intricacies of interaction of situa- 
tional factors, and the fact that most treatment work by the 
student was carried on away from the Institute and so di- 
vorced from immediate staff help, made the study of the 
training methods in this setting of particular interest. 

Miss Swift has outlined the way in which the Institute met 
these problems. 1 Stubborn though not insuperable obstacles 
were encountered. The most difficult one was that so many 
cases had to be carried by student workers in all fields. This 
imposed a heavy burden on supervisors, and explains the su- 
pervisory set-up of the Institute. 

The study here presented is particularly important because 
it shows how closely the training methods were related to the 
individual student and her needs. It seems clear that statistical 
evaluation of work, such as is set forth in this study, has its 
chief value in illuminating the needs of the particular stu- 
dent. In other fields of clinical training, it may be possible to 
lay more emphasis on what are commonly called objective or 
concrete findings, and permissible perhaps to disregard the 
reactions of students, though I doubt it. But it is certain that 
in work with family relationships this is never possible the 
very conditions to be met are so common to us all and the 
personal reactions so emotionally upsetting to many of us, 
that genetic relationships must always be borne in mind. The 
inescapable conclusion from this study is that adequate super- 
vision of students in the mental hygiene field involves a cer- 

i Detailed material regarding the difficulties encountered in programs for simultane- 
ous training of several professional groups of disparate training, outlook, and expecta- 
tions will be found in: 

a) Lawson G. Lowrey, M.D., and Geddes Smith, The Institute for Child Guidance 
1927-1933 (New York: The Commonwealth Fund, 1933). 

b) Lawson G. Lowrey, M.D., Five Years' Experience in Supervision of Psychiatrists, 
Psychologists and Psychiatric Social Workers in Simultaneous Training (Report 
of Section Meeting, 1933), American Journal of Orihopsychiatry, 3 (3): 278- 
309 (July, 1933). 



Xll TRAINING IN PSYCHIATRIC SOCIAL WORK 

tain amount of therapeutic approach. It is essential, according 
to our experience, that this be kept to a minimum and related 
only to case work failures or blockings. 

Miss Swift has made an objective evaluation of the experi- 
ence of the Institute staff over a period of six years. The en- 
tire staff of the Institute joined in the collection of the data 
on which her study is based. She, however, has performed 
the arduous task of presenting and analyzing the data and of 
setting forth the evaluation of the staff thinking on training 
problems. As case work supervisor and later as educational 
supervisor, in intimate contact with students and staff mem- 
bers, she was in a strategic position to interpret the training 
experience. The findings are offered for careful study by all 
serious observers in the field. It is to be hoped that further 
work in other centers may clarify some of the pressing prob- 
lems still unsolved. 

LAWSON G. LOWREY 

September, 



INTRODUCTION: CHANGES IN CONCEPTS 

OF TRAINING IN PSYCHIATRIC 

SOCIAL WORK 



FACILITIES for training psychiatric social workers rep- 
resent provision for a relatively recent specialization in 
the field of social work. The multiplicity of changes in con- 
tent and method of training which has taken place in the 
short time since it was established, indicates the extreme fer- 
tility and rapidity with which this branch of social case work 
has developed. The concepts and philosophy of social psy- 
chiatric therapy have been and are still being modified by the 
thinking of psychiatrists and psychiatric social workers, and 
by experiences in non-psychiatric agencies where the formu- 
lations of psychiatric social work are constantly being uti- 
lized. Present trends had their origin in the earlier historical 
phases of mental hygiene and it is there that the sources of 
the modern social psychiatric point of view will be found. 

During the first quarter of the century, there were indica- 
tions of a new and more hopeful approach to the problems of 
mental illness. Great progress was being made in understand- 
ing the purposiveness of human behavior, and the causative 
factors underlying the social or asocial responses of the indi- 
vidual to his environment. From this understanding a 
marked therapeutic advance in the treatment relationship de- 
veloped. Among individuals whose contributions to this 
progress were outstanding are Doctors Herman M. Adler, 
C. Macfie Campbell, Bernard Glueck, William Healy, 
Marion E. Kenworthy, David M. Levy, Lawson G. Lowrey, 



2 TRAINING IN PSYCHIATRIC SOCIAL WORK 

Adolf Meyer, Thomas W. Salmon, Elmer E. Southard, 
William A. White, and Frankwood E. Williams. 

The beginnings of psychiatric social work occurred during 
this period of advance in psychiatric thinking. Social service 
workers were detailed to work under psychiatrists in state 
hospitals and with clinic or hospital patients in several com- 
munities: Baltimore, Boston, Chicago, and New York. This 
beginning application of social work techniques within the 
field of psychiatry received a great impetus in 1917-1918 
due to the demands for psychiatric service resulting from the 
war. Psychiatrists, aware of the potential value of social 
workers in the usual psychiatric services, saw an opportunity 
of developing valuable assistants in dealing with the large 
numbers of men who had developed conditions requiring 
psychiatric care under the strain of war service. In order to 
assist in meeting this emergency, a special training course 
the Smith College School for Social Work was organized 
by Dr. Southard and Miss Mary C. Jarrett. This was the first 
attempt to provide systematic training in this new field of 
work. During the same year, 1918, courses in mental hygiene 
were included in the curriculum of the New York School of 
Social Work and by 1920 integration of theory and practice 
in field work was being realized in the training of psychiatric 
social workers at this school under the leadership of Dr. 
Glueck and Dr. Kenworthy. At this time, facilities for field 
work training were necessarily limited to mental hospitals 
and psychiatric clinics of the out-patient departments in large 
general hospitals. 

In 1921, special opportunities for valuable field work ex- 
perience were made possible through the establishment of the 
Bureau of Children's Guidance by the Commonwealth Fund. 
The Bureau, under the medical directorship first of Dr. 
Glueck, later of Dr. Kenworthy, functioned as a child guid- 



INTRODUCTION 3 

ance clinic for the study and treatment o behavior problems 
in children, and as a center for field work training for stu- 
dents in psychiatric social work from the New York School. 
In providing for this kind of case and this type of training we 
see a reflection of the emphasis beginning to be placed at this 
time on the importance of work with children. The possibili- 
ties for achieving more satisfactory results in therapy were 
recognized in working with children through helping to 
shape their environmental influences during the formative 
years, and bringing them into a more harmonious adjustment 
at home, at school, and at play. Further evidence of this 
trend is found in the general expansion of programs for child 
guidance in these years. 

Coincident with the opening of the Bureau, under the 
Commonwealth Fund program, the National Committee for 
Mental Hygiene began a five year demonstration of child 
guidance work which resulted in the establishment of such 
clinics in eight different cities in the United States. These 
clinics, together with similar clinics established earlier in Chi- 
cago ^nd Boston by Dr. Healy, 1 served to enlarge the field 
of psychiatric social work. By this time mental hygiene 
courses had been incorporated into the training programs of 
other progressive schools of social work beside the two origi- 
nal ones, and recognition of the importance of focusing on 
behavior problems in children was common to all. 

Concurrently, case workers in all social agencies, irrespec- 
tive of the particular administrative setting in which they 
were working, were gradually becoming aware of the help to 
be obtained from psychiatric resources in their own case work 
responsibility 5 and the thinking of the community was be- 
coming permeated by mental hygiene concepts, through 

I Juvenile Psychopathic Institute, Chicago, founded in 1909 (now the Institute for 
Juvenile Research) and Judge Baker Foundation, Boston, established in 1917 (now 
the Judge Baker Guidance Center). 



4 TRAINING IN PSYCHIATRIC SOCIAL WORK 

popular literature, lectures, and contacts with professional 
workers in the field. This brought an increasing demand for 
psychiatric service from parents, teachers, and others con- 
cerned with handling difficult children, which tended to fur- 
ther the development of psychiatric social work. 

The rapid expansion of child guidance throughout the 
country called for trained personnel to fill the positions thus 
made available. In response to this need, following the clos- 
ing of the Bureau of Children's Guidance in 1927, the Insti- 
tute for Child Guidance was established by the Common- 
wealth Fund. The functions of the Institute were: first, to 
serve as a training center 5 second, as a child guidance clinic to 
handle cases of emotional unadjustment in children} and 
third, to do research based on the clinical and training pro- 
grams. The training opportunities included field work for 
students of psychiatric social work from both the New York 
School of Social Work and the Smith College School for So- 
cial Work and specialization in child guidance work for psy- 
chiatrists and psychologists. 

The team work relationship of psychiatrist, psychologist, 
pediatrician, and psychiatric social worker at the Institute 
provided for an intensive sort of initial exploration into the 
child's personality and environment. The contribution from 
each field was considered essential in most cases to the psy- 
chiatrist's grasp of the underlying causative factors in the 
situation. The insight thus obtained was utilized by him in 
planning his therapeutic relationships with child and family. 
This procedure furnished a short cut that was of great value 
since it enabled the psychiatrist to carry many more cases 
than he could otherwise handle adequately. 

For a considerable period of time in many centers the ob- 
jective of release of psychiatric time continued to be seen as 
of major importance in child guidance clinics. This was a 



INTRODUCTION 



natural outgrowth of conditions in organizations sorely 
pressed to provide help on problems of emotional adjust- 
ment as adequately as possible in terms of number of cases 
and value of service. Necessarily, then, in the earlier days, 
the formulation of training concepts was largely controlled 
by this objective, with the result that emphasis was placed on 
the selection of significant material to be included in the 
lengthy and detailed social examinations for the use of the 
psychiatrist. Relatively superficial techniques of treatment, 
mostly in terms of manipulating the environment, were uti- 
lized by the psychiatric social workers to aid the psychiatrist 
in working with the child. 

There was a gradual shift from this point of view as inten- 
sive work with children brought the realization that except in 
some of the adolescent cases which might be handled in much 
the same way as adults, direct treatment can often be carried 
on most effectively with one or both parents, or with some 
other adult holding a key position in the family constellation. 
The change in treatment emphasis put an increasingly great 
responsibility on the social worker, at the same time opening 
up for her a vast new area of opportunity. 

From this point, which was arrived at earlier in some train- 
ing centers than in others, the challenge to the social worker 
inherent in the more vital relationship with her client has- 
tened the moment when she could clarify for herself social 
psychiatric concepts and apply them in her work. At this 
time, the potentialities of interaction between psychiatry and 
social case work were effectively realized and in so far as 
these potentialities have been sustained and nurtured, there 
has been steady growth and maturation in psychiatric social 
case work. The integration of psychiatric theory with practice 
achieved in handling the client relationship became then for 
the social worker the dynamic source of her ability to grow 



6 TRAINING IN PSYCHIATRIC SOCIAL WORK 

and profit by the professional contacts with clients and asso- 
ciates. Her position, in other words, had shifted from that of 
a somewhat detached auxiliary to one of greater responsi- 
bility and creative opportunity. 

In an ideal relationship between psychiatrist and psychiat- 
ric social worker, the work of the two would be so closely 
integrated that the client could accept both as sources of help 
without making one or the other the sole focus of his emerg- 
ing emotional needs. Such complete collaboration is probably 
seldom achieved. It may be approximated in a clinic where 
the philosophy of case handling and the conviction of both 
individuals participating in treatment allow for a shared 
therapeutic relationship. In working out the joint approach, 
the two associates would help the client to use the relation- 
ship as the means of recognizing his own needs and capacities 
but on a level relatively near the surface of consciousness. 
Exploring the deeper levels of the unconscious is not usually 
possible in the child guidance clinic unless the therapist is in 
a position to assume total responsibility for treatment of the 
individtial. 

The potentialities of the collaboration of psychiatrist, psy- 
chologist, and social worker were early recognized in some 
centers. The value that results from a smoothly working and 
essentially mature team work relation, in helping a child 
achieve a more harmonious adjustment to life still seems to 
many clinicians, at this stage of therapeutic advancement, a 
factor of the greatest importance. As its increasingly enriched 
possibilities for community service have become apparent, the 
procedure has come to be the usual basis of child guidance 
clinic administration. 

The values that have emerged from the case work and re- 
search of such clinics for the understanding of behavior have 
been great. In this connection, Dr. Kenworthy writes: 



INTRODUCTION 7 

The whole mental hygiene field has been vastly enriched by the 
research material from the psychoanalytic group, but especially in 
child guidance work, where our primary concern is the handling of 
the child-parent problems, do we find practical proof of the psycho- 
analytic concepts. Child guidance then can be looked upon as a natu- 
ral outcome of our work in adult psychiatry. Without the back- 
ground of psychiatric knowledge, plus the contributions from psy- 
choanalytic, psychological, sociological and biological fields, work in 
the guidance of children would have developed on the same unpro- 
ductive levels of symptomatic treatment and diagnostic classification. 
There are even to this day occasional attempts to reestablish the old 
time method of classifications, i.e., the nervous child, the unstable 
child, the hyperkinetic child, etc. For the most part, however, one 
finds a steady insistent effort being made by psychiatrists, psycholo- 
gists and social workers to see the case as a whole. 2 

While it is probably true that this effort "to see the case as 
a whole" is characteristic of the work today in most child 
guidance clinics, and of the philosophy underlying training 
in these centers, it has become the prevailing philosophy in 
many clinics only within the last few years. Even now there 
are still some centers that put their emphasis in treatment on 
symptomatic behavior, on the simple suggestion level of 
therapy focused chiefly on the child without due considera- 
tion of the cause-and-effect elements which underlie the 
symptomatic pattern that he presents. Dr. Frederick H. 
Allen has summarized the differences in these two methods 
of approach as follows: 

This desire to change behavior by working rather directly with the 
child either by means of star charts, systems of rewards, or semi- 
moralizing and working with the parent on a habit training basis 
marked a great deal of our earlier treatment philosophy. Lately there 
has been a feeling of futility and of the need for a more direct ap- 
proach to the fundamental factors in the relationships of the home. 

2 Marion E. Kenworthy, The New Social Philosophy, chapter i, Children and Their 
Parents, by Maude E. Watson (New York: F. S. Crofts & Co., 1932). 



8 TRAINING IN PSYCHIATRIC SOCIAL WORK 

One of the unhealthy features of this focusing on changing the 
behavior of the child by direct but superficial means is that it has pro- 
vided the adults with another excuse for avoiding the necessity of 
facing these problems of their own which bear a causal relationship 
to the behavior of the child. It overlooks a fundamental principle in 
modern psychiatry namely, that behavior is reactive and adaptive 
and expresses the way in which the individual is meeting a situation. 
It does not seem sound, therefore, to attempt to change the behavior 
without altering the factors that have contributed to its development. 
That is exactly what we attempt to do when we allow ourselves to be 
pushed onto a specific suggestion level. To keep away from this level 
is one of the most difficult tasks that confronts the psychiatrist and 
the social worker in the field of child guidance, and to do it means 
that there must be a rather clear objective in their relationship with 
parents from the very outset. ... A fairly direct and sympathetic 
working out with the adults of their own attitudes and relationships 
not only with the child, but with other adults, particularly those in 
their marital and family situations seems the objective toward 
which we are working in the field of child guidance. 3 

In the later tendency, articulated some years ago but still 
characteristic o certain modern progressive trends, to swing 
away from direct treatment of the child toward work with 
the adults in the family, there is danger of overspecialization 
and overemphasis, as Dr. Allen indicates. 4 In the realities of 
the treatment situation in a child guidance clinic, the thera- 
pists concerned must constantly remember that it is their re- 
sponsibility to help build up for the child those habitual pat- 
terns of behavior response to his environment which will be 
most conducive to his progressively healthy adaptation. This 
can only be achieved through understanding and dealing 
with the interacting relationships between the child and his 
family as they manifest themselves in the total situation. Ob- 
viously every individual in the family group does not have to 

3 Frederick H. Allen, M.D., Evolution of our Treatment Philosophy in Child Guid- 
ance, Mental Hygiene, 14:111 (January, 1930). 

4 Frederick H. Allen, M.D., op. '/., page 8. 



INTRODUCTION 



be treated simultaneously} perhaps only one or two of them, 
not necessarily including the child, need be treated directly, 
if the therapists are constantly in contact with and aware of 
the emerging factors in the case as a whole. 

In attempts to approximate the goal of more complete case 
understanding, practice in the child guidance clinics does not 
always follow the pattern of the team work relationship. In 
some clinics emphasis is placed rather on centralization of ef- 
fort, a worker from only one professional field having 
charge of the whole treatment area, whether both child and 
family are treated or whether one individual of the group is 
treated. Such variations in procedure are seen as essential 
parts of the growth process, which without experimentation 
would tend to become crystallized and static. Training is 
naturally affected by these shifts in emphasis. 

As social case work is more vitally related to psychiatry, 
the line of demarcation between the two becomes less clearly 
defined. Perhaps it was inevitable that, in the swing away 
from case work treatment on the social manipulative level, 
the social worker should tend to reject the broad area of the 
child's environmental setting, traditionally allotted to her 
for treatment, in favor of more intensive work with one or 
two individuals. 

Combined with this trend in treatment is the tendency on 
the part of some psychiatrists and social workers to seek in 
psychoanalysis a clearer insight into motivations of behavior. 
This experience frequently brings to their relationship with 
others a keener sensitivity and a more profound understand- 
ing. To others vital relationships with members of the staff 
in handling case work responsibility are found sufficient 
stimulus in assimilating and integrating social psychiatric 
concepts. However, at the present time an increasing number 
of workers in both fields who have had the experience of ex- 



IO TRAINING IN PSYCHIATRIC SOCIAL WORK 

ploring the unconscious levels of their personalities tend to 
question the adequacy of therapeutic results brought about by 
the more active social psychiatric approach. In such instances 
in the treatment of others they may emphasize as important 
the creation of a relationship between client and therapist in 
which the former works out his emotional conflicts as far as 
he is able with a less active participation by the therapist. In 
attempts to establish such a relationship the therapist will 
often assume the total responsibility for the case himself, and 
focus his approach on one member of the family group, 
whether it be child or adult. 

Shall we say, then, that we are entering a new era, in 
which team work, in the familiar sense of shared therapeutic 
responsibility, will be abandoned? While such a question is 
bound to arise in the minds of psychiatric social workers or 
others seriously interested in the growth of the profession, to 
many it may seem still too early to arrive at even provisional 
conclusions on this point. Content and method of the profes- 
sion have changed, and must continue to change to keep 
abreast of experimentations and the resultant expansion of 
our knowledge and understanding. But while frontiers are 
rapidly receding, it is perhaps not yet possible to predict in 
what direction the richest areas for cultivation will be found. 
To be able to help the client in the way he can best profit by 
such help, in terms of his own capacities and limitations 
rather than according to the therapist's ideal of so-called 
good adjustment is not seen as a new concept. The recogni- 
tion of the importance of this point of view emerged very 
early in social psychiatric practice in child guidance clinics. 
However, the challenge to keep this objective constantly be- 
fore us which comes from groups experimenting with thera- 
peutic approaches different from our own, must be recog- 
nized as exceedingly vital and stimulating. 



INTRODUCTION II 

If the social worker or psychiatrist, in the effort to achieve 
personal and professional growth, can constantly strive not 
only toward freedom to identify with others in order to es- 
tablish a dynamic treatment relationship, but also toward 
freedom to detach himself in the relationship and to retain 
intact his own objective integrity, then we need not be con- 
cerned about the direction of change in either profession, 
since growth is inherent in and inseparable from such a con- 
cept. 

If in the future the therapist becomes more secure in his 
ability to set the client free to achieve his own growth on his 
own terms, we may perhaps logically anticipate that he will 
tend to become more flexible toward the means by which this 
end can be achieved. He will then perhaps be more objective 
and discriminating in establishing a relationship based on his 
understanding of the need of the client, rather than on a pos- 
sibly subjective identification with one or another type of ap- 
proach. The initial responsibility and opportunity for such 
progress lies with those in charge of training. 

In reviewing the work of the Institute for Child Guid- 
ance, we may see how it has been possible to work out in that 
center through years of experience certain techniques of 
training. However, it must be recognized that it was not in 
the formulation of these general principles but in their adap- 
tation to the individual situation that the objectivity, re- 
sourcefulness, and creative imagination of the staff were pri- 
marily put to the test. It is in this direction, then, that the 
essential art of training lies, and while we should not wish to 
minimize the value of accumulated knowledge and develop- 
ment of skills, it is only through our own wish to grow and 
mature that we can achieve the fundamental strength and 
perspective which may serve to stimulate in others the wish 
to develop a creative fulfilment in their own terms. 



II 

THE TRAINING PROGRAM AT THE 

INSTITUTE FOR CHILD 

GUIDANCE 



IN undertaking this study, two points of special importance 
were selected for consideration: first, the actual experience 
of students in psychiatric social work at the Institute for 
Child Guidance so far as records were available ; second, the 
philosophy of training underlying this experience with spe- 
cial emphasis on the distinction between those factors which, 
in both theory and practice, were found to be relatively con- 
stant and those which were changing or evolving. The em- 
phasis throughout is on what has actually happened during 
an experimental training period in one specific organization, 
rather than on what ideally a training program should in- 
clude. However, as certain trends emerge from this exposi- 
tional survey, whether constructive or destructive, these will 
perhaps clarify our thinking on the general subject of train- 
ing, and may serve as a basis for sounder planning in the fu- 
ture. 

The Clinical Set-Up 

In turning to the setting at the Institute into which social 
service students came for training, we find that the perma- 
nent staff was a relatively constant factor each year. This was 
true in regard to number of personnel, until the reductions in 
staff in the year 1932-1933 necessitated by the closing of the 
organization at the end of that period. The number of f el- 



THE TRAINING PROGRAM 13 

lows in psychiatry, with whom the students worked closely, 
varied from year to year. 

The following list shows numbers, but not replacements, 
in personnel for the permanent professional staff from 
1927-1933, in the administrative and clinical departments. 
The number of fellows in psychiatry and psychology for 
these years is also given. No fellows were accepted for train- 
ing in psychology during the Institute's last year. 



PERMANENT PROFESSIONAL STAFF 
1927^933 

Administrative staff 

Director 

Chief of staff 

Chief of social service 

Clinical staff 

Psychiatrists 

3 from 1927 to 1930 

4 from 1930 to 1932 

2 from 1932 to 1933 
Pediatrician 

I from 1927 to 1932 

Technician in pediatrics 
I from 1927 to 1932 

Psychologists 

3 from 1927 to 1932 

2(1 full-time, i part-time) from 1932 to 1933 

Psychiatric social workers 
12 from 1927 to 1928 
15 from 1928 to June 1932 
9 from June 1932 to June 1933 



14 TRAINING IN PSYCHIATRIC SOCIAL WORK 

FELLOWS IN TRAINING 



Fellows in psychiatry 

3 from 1927 to 1928 8 from 1930 to 1931 

6 from 1928 to 1929 6 from 1931 to 1932 

5 from 1929 to 1930 4 from 1932 to 1933 

Fellows In 'psychology 

3 from 1927 to 1932 

NOTE: Auxiliary administrative services, statistical, library, stenographic, and cleri- 
cal, were maintained in proportion to meet the needs of the professional staff in mak- 
ing the clinical work proceed smoothly and effectively. 

The requirements for fellowships in psychiatry were as 
follows: "an M.D. degree, preferably an interneship in a 
general hospital, and a sufficient experience in psychiatry in a 
hospital with an active clinical program to make sure that the 
candidate was adequately grounded in psychiatric funda- 
mentals." 1 This did not necessarily include psychiatric work 
with children, and in general the psychiatric fellows had had 
no contacts with child guidance before entering the Institute. 
Ordinarily in any given year, about half the fellows in psy- 
chiatry began their training in July, and the other half in 
September, although there was considerable latitude and a 
few fellows entered the Institute at other times. In general, 
it may be said, however, that at least half the fellows began 
their training each year in the fall concurrently with the 
Smith College School students and with the major group of 
New York School students. 

The fellows in psychology all entered in the fall. The re- 
quirements for candidates for psychological fellowships were 
"that they should be graduate students majoring in psy- 
chology, possessed of a master's degree, with a background 

I Director's report, 1929-1931. 



THE TRAINING PROGRAM 15 

of experience in mental testing such that they had the neces- 
sary facility in using their major tools." 2 

While training under the large and varied program out- 
lined here was conceived as the primary function of the In- 
stitute, the case work carried was necessarily its major re- 
sponsibility. It is obvious that since the Institute carried these 
two types of responsibility, a large professionally trained 
staff was essential. To quote again from the director's report : 

Accordingly it became necessary to establish three case working or 
clinical units, each with a psychiatrist in charge, a psychologist, and 
two social workers. To each unit was then assigned its proportion of 
fellows and students who became integral parts of the unit staff. In 
effect, this gave three child guidance clinics, each a part of the 
whole, and yet independent of the others. 

From 1930 to 1932 a fourth unit, composed of staff mem- 
bers only, was established to work out a greater refinement of 
treatment techniques than is often possible in a training 
group, and to carry forward research in treatment methods. 
While no attempt was made definitely to integrate the work 
of this unit with the training program, current material was 
presented by members of the group from time to time in 
general staff discussions, participated in by students and fel- 
lows as well as by staff members. 

In general, the major emphasis in training was placed on 
the careful study of individual cases and on direct work with 
them in consultation with a staff member. The staff psychia- 
trists, the director, and the chief of staff assumed the main 
responsibility for the training of fellows in psychiatry, and 
the staff psychologists for the training of fellows in psy- 
chology. Those members of the social service staff who car- 
ried case work responsibility, and who for convenience may 
be referred to as case work supervisors, were primarily re- 

2 Ibid. 



l6 TRAINING IN PSYCHIATRIC SOCIAL WORK 

sponsible for the training of the students in social work. Be- 
cause of somewhat different plans of operation in the two 
schools from which the social service students came (the 
Smith College School and the New York School), it was con- 
sidered necessary to appoint for each of these groups an edu- 
cational supervisor from the social service staff. The aim of 
this worker was to cooperate with the case work supervisors 
in an attempt to coordinate and integrate the work of the stu- 
dents, individually and as a group, with the program of each 
school concerned. The educational supervisors worked closely 
with the respective schools and were appointed with the ap- 
proval of the directors of the schools. The chief of social 
service kept in touch with the general aspects of the training 
program for the students of social work by maintaining an 
individual and group consultant relationship with the social 
service staff and with the staff members and fellows in psy- 
chiatry and psychology and by holding occasional group dis- 
cussions with the students. Her aim was to help the students 
relate their case work, their relationships within the agency, 
and their contacts with other social agencies to the adminis- 
trative functions and policies of the Institute. 

While the primary responsibility for training was vested 
in the staff members representing the fields of psychiatry, 
psychology, and social work respectively, there was neces- 
sarily and advisedly a great deal of overlapping. The conse- 
quent interchange of ideas and responsibilities helped to 
broaden and integrate the case work philosophy of the mem- 
bers of each clinical division. There were, of course, certain 
difficulties for the students in adjusting to a team work rela- 
tionship, particularly since the fellows in psychiatry and psy- 
chology, when they came to the Institute, were also inexperi- 
enced in child guidance work. Some of the advantages and 
disadvantages of working out the training needs of the three 



THE TRAINING PROGRAM 17 

groups in such close give and take will be discussed in the fol- 
lowing pages. 

Insistence on the importance of the team work relationship 
in case handling may be seen as the logical outgrowth of the 
general philosophy of child guidance, and the fourfold ap- 
proach in study and treatment. Ordinarily, all cases accepted 
for treatment service at the Institute were assigned to the 
joint responsibility of psychiatrist, psychologist, pediatrician, 
and social worker, since examinations in all these fields at an 
early point in case handling have been generally accepted in 
child guidance practice as essential to understanding the 
issues and implications in a given case. Following the exami- 
nations and initial discussion by the clinical unit of the mate- 
rial obtained in each field of study, treatment responsibility 
was assigned to the different members of the group in the 
way which appeared best to meet the needs of each particular 
situation. Since every effort was made to avoid a routine con- 
sideration of cases and to treat each situation individually, 
exceptions to the procedure described above were made when 
this seemed indicated. 

Portions of organization work were concentrated in the 
hands of those social service staff members who did not have 
responsibility for training but whose work had important 
bearing on the experience of the students j for example, re- 
sponsibility for registration, initial interviews, and accept- 
ance, or other decisions on cases referred to the Institute, was 
vested in a staff social worker. This social worker, accessible 
to the whole professional staff, familiar with the special in- 
terests of each member, and capable of recognizing the im- 
portance of the particular case for training, research, or other 
purposes, consulted with the members of the unit staffs on 
the assignment of cases. Discussion of current policies and 
current thinking relating to the important subject of admis- 



l8 TRAINING IN PSYCHIATRIC SOCIAL WORK 

sions was from time to time initiated with student social 
workers, with a view to mutual understanding. During sev- 
eral years, students were also assigned to work with the staff 
member responsible for referral interviews. 

Since all applications had to be cleared through the Social 
Service Exchange, the work and plans of other agencies 
which might be active on the case had to be discussed as a 
preliminary to treatment. Such discussion provided a frame- 
work in which the assigned student social worker had to find, 
with the aid of the case work supervisor, her subsequent 
place on the accepted case. For a considerable period of time, 
a referral committee, representing the views of members of 
all four clinical divisions, functioned to discuss difficult ques- 
tions in connection with intake of cases and initiation of study 
and treatment. Students attended such meetings as part of 
their work with applications. 

Types of Service 

Various types of service were offered at the Institute. 
When the application interview showed that the desired 
service could be better obtained through another channel, ad- 
vice was given on the resources available and the best means 
of approaching them and no further contact was made on the 
case. This was advice service. If the application interview in- 
dicated that the Institute might be able to help the problems 
described, the case was assigned to consultation service, which 
meant that examinations were made, usually in all of the 
four fields , if these examinations seemed to warrant it, the 
case was then assigned to treatment service. Within the gen- 
eral classifications of treatment, there was specialization to 
meet the needs presented by certain groups of cases. 

Cases treated for a relatively long period were often re- 
ferred to at the Institute as "intensive service" or "intensive 



THE TRAINING PROGRAM 19 

treatment" cases, and for convenience these terms will be 
used in this sense throughout the study. Such cases were usu- 
ally seen at least once a week for a considerable period of 
time. The term "intensive service" is not to be confused with 
the term "intensive level" (Item 24 on the supervisor-stu- 
dent chart, page 113) which has reference to the degree of 
skill shown by the worker in her therapeutic approach to the 
case, whether the particular case in question required brief or 
long-continued treatment. 

Certain cases were referred from case working agencies 
which carried the primary responsibility for planning and for 
treatment. Work on these cases, cooperative case work as this 
is usually termed in community clinics, was maintained ini- 
tially for its training value to clinicians and social workers as 
having relevance to their subsequent community functioning. 
It was known from previous experience that a newly organ- 
ized clinic must develop its working relationships with the 
community through a mutual recognition of the problems of 
the referring agency and of the techniques available at the 
clinic. Responsibility for such cooperative service at the Insti- 
tute was centralized for a time, and always vested in social 
service personnel. Accordingly, one staff social worker, either 
on full time or in conjunction with the handling of general 
intake, concentrated for several years on this portion of the 
work. She arranged appointments and conferences between 
referring agency and clinic and participated in the activities 
of both in a way to facilitate joint planning and working by 
agency and clinic. Social work students were encouraged to 
attend staff conferences on cooperative cases, in order to 
benefit from discussion with the workers of other agencies on 
problems peculiar to their fields and less frequently encoun- 
tered at the clinic. Group discussion on the subject was also 
instituted between the cooperative supervisor and students. 



2O TRAINING IN PSYCHIATRIC SOCIAL WORK 

Later, when the clinic and agency understood one another bet- 
ter and the plan proved agreeable to the agency, clinical re- 
sponsibility for cooperative work was allocated to the case 
work supervisors. The supervisor delegated work on ar- 
rangements and planning with agencies to the student social 
worker, or at least let her share in such activity. It was felt 
that actual participation by the student would heighten the 
value of this type of work for her. However, because of the 
large turnover of the student group, the responsibility that 
could practically be given the student was not sufficient to 
provide an adequate reality situation without diluting the 
value to the case and to the referring agency. Cooperative 
treatment service was therefore terminated, in spite of its 
potential importance to the student. 

A one-day diagnostic consultation service was then insti- 
tuted to meet the most immediate needs of the agencies and 
to provide fellows and social service students with a certain 
degree of work with these agencies. This type of service con- 
tinued to the end of the Institute's work. Occasionally the 
same type of service was given to out-of-town parental refer- 
rals, when it was considered possible to meet their particular 
needs in this way. These situations offered the students an ex- 
cellent opportunity for taking a minimal history, in the 
process of which all her resources of knowledge and skill 
were tested, by the necessity of obtaining the maximum of 
essential data in the brief space of one or two hours. Since 
greater skill was required in making this selective sort of ex- 
amination than the usual one, which was fuller in detail, 
more active supervision was given to the student's prepara- 
tion for it, and special opportunities were provided for the 
student to consult with the supervisor at any point during the 
examination interview at which she might feel the need. 

One of the important community relationships in connec- 



THE TRAINING PROGRAM 21 

tion with the acceptance of cases was with private medical 
practitioners currently active on cases. Of the total number of 
cases applying during the time the Institute was in existence, 
3.14 per cent were referred by private physicians. Contact 
was made with the physicians in order to explain that the 
function of the clinic involved no medical treatment, only 
recommendations, to win cooperative understanding of the 
clinic's approach to the case, and to ascertain whether there 
was any unwillingness on the part of the doctor to let the 
clinic enter the situation. 

The assistant director of the Smith College School func- 
tioned part time as research assistant, making special project 
studies which, prior to publication, were presented from time 
to time to staff and training groups for their suggestive 
value. 

The Selection of Students 

Students in training at the Institute came from two schools 
of social work the New York School and the Smith College 
School. The selection of the candidates was based on the in- 
formation supplied by the schools which covered age, educa- 
tion, professional training in case work or other fields, and 
previous experience either in case work or non-case-work, 
with dates indicating the length of these experiences. The 
number of students applying each year varied with the num- 
ber of students for whom each school was seeking field work 
opportunities, and the number accepted depended on the 
training policy of the Institute. 3 

The problem of accepting the students who might profit 
most from the sort of training offered by the Institute was 
perplexing and difficult. The experience gained each year 

3 See page 25, for the number of students from both schools accepted for training 
in the years 19271933. 



22 TRAINING IN PSYCHIATRIC SOCIAL WORK 

from a trial-and-error method of selection deepened the con- 
viction of the staff that little progress in refining techniques 
of evaluating candidates was possible so long as adequate in- 
formation was lacking. It was open to question how much 
value there was in weighing such matters as age, previous 
training and experience, vocational aspirations, and the like, 
if it was not known what use had already been made of these 
factors and what led the candidate to make one type of social 
case work rather than another her objective after training. 
We might pride ourselves that we were very astute in read- 
ing between the lines of the candidates' application forms. 
We might detect, perhaps, in one student's record a con- 
tinuity of educational experience which, combined with 
progressively responsible positions in professional work, was 
suggestive of a purposiveness in planning her life very fa- 
vorable to a prognosis of further growth. In the same way, 
we might decide from another's record that she would clearly 
not fit into the present training situation at all, because she 
was too old, her education had been erratically planned, she 
had done no case work until very recently, and had held posi- 
tions calling for little initiative. And yet not all the candi- 
dates who appeared to have the best prognosis adapted suc- 
cessfully to the training situation, and of the students ac- 
cepted experimentally who had a background similar to the 
last one quoted or equally destructive in its implications, 
more than one showed a maturity and adaptability, a willing- 
ness to learn, and an objectivity in her attitude toward stu- 
dents better equipped technically, which enabled her to get 
the maximum from her experience at the Institute. 

How, then, is one to decide which candidate to prefer to 
another? In many training centers it is not possible from an 
administrative point of view to have an interview with each 
candidate. Must we say, then, that there should be no at- 



THE TRAINING PROGRAM 23 

tempt to select or discriminate beyond ascertaining that the 
prospective students have the minimum qualifications de- 
manded by the schools which sponsor them? Or can we say, 
after carefully reviewing the progress and attainments of the 
289 students trained at the Institute, that those falling 
within a certain age span and having the background of a cer- 
tain amount of case work experience have profited more from 
the training, as far as we can measure it, than those older or 
younger, and with more or less experience; and that, there- 
fore, we may be directed by these tentative conclusions in the 
selection of the most hopeful candidates? In consideration of 
the widespread interest in these questions on the part of 
schools of social work, training centers, and committee mem- 
bers dealing with the knotty problems of donating scholar- 
ships, it would seem that a study of experience at the Insti- 
tute would be rewarding and would clarify thinking along 
these lines. This subject will therefore be considered at some 
length in Chapter VL 

Class Work in Relation to Field Work 

All the students from the Smith College School had had 
approximately two months of class work in the theory of 
mental hygiene and in subjects designed to give either a gen- 
eral orientation to social work or a more specific orientation 
to generic case work. 4 One course in community case work 
was given concurrently with field work training. Following 
the nine month period of field training, at the Institute or 
some other center, that is required by this school, the students 
returned to Smith for another two month period during 
which they attended classes and completed their theses. 

The large majority of the New York School students, on 

4 For a discussion of generic case work, as distinguished from specialized case work> 
see Social Case Work: Generic and Specific; An Outline, A Report of the Milford 
Conference (New York: American Association of Social Workers, 1929). 



24 TRAINING IN PSYCHIATRIC SOCIAL WORK 

the other hand, were taking courses in mental hygiene, and in 
social work and social case work as well, at the same time that 
they were carrying field work at the Institute, their time in 
most instances being about equally divided between the two, 
in accordance with the general policy of this school as to divi- 
sion of student time. While it was possible, under the flexible 
provisions for training afforded by the New York School, that 
students entering the Institute might previously have taken 
all or practically all the courses in mental hygiene in the cur- 
riculum, it was also possible that they might not have had any 
of these courses. The latter condition was generally true, for 
example, of the students in training on Commonwealth Fund 
fellowships, under the terms of which they took three quar- 
ters 5 of specialized training in psychiatric social work, their 
time being divided between field work and class work. This 
was also true of some of the other students who were at the 
school and at the Institute for only three quarters, but were 
considered to have had a sufficiently substantial experiential 
background of social case work to make it profitable for them 
to specialize in psychiatric social work during their entire 
training period. A few one and two quarter New York 
School students had had no instruction in the theory of men- 
tal hygiene. Since it was generally felt by all those directly 
concerned with student training that some orientation in 
mental hygiene was essential at the start of the training pe- 
riod for students who had not been able to benefit by this 
earlier, it was arranged in 1929 that the school should give 
such students the advantage of two or more courses in mental 
hygiene concurrently with the first quarter of their field 
work experience. This did much to obviate the dissatisfaction 
expressed by students who had felt that it was not possible to 

5 A quarter is the unit of time given to training and represents a period of approxi- 
mately twelve weeks. 



THE TRAINING PROGRAM 25 

gain a maximum benefit from the case work experience with- 
out a wider background of theory than it was possible for the 
supervisor to supply. The diploma candidates at the New 
York School, who were required to complete six quarters of 
combined class work and field work or their equivalent, had 
taken at least two courses in mental hygiene before coming 
to the Institute. Many of the candidates from both schools 
had had one or more courses in mental hygiene in connection 
with college or postgraduate work. 

Number of Students and Length of Training 

Each year the majority of the students presented them- 
selves for training in the fall, the Smith College School stu- 
dents in September and the New York School students in 
October. A few students from the latter school entered the 
Institute at the beginning of the winter and spring quarters 
and a somewhat larger number, since there were no Smith 
College School students during this period, at the beginning 
of the summer quarter. The number of students accepted 
from both schools each year from 1927-1933 is shown in 
the following tabulation. 

Smith College New York 

Year School students School students 

1927-1928 8 42 

1928-1929 15 44 

1929-1930 18 36 

I 93- I 93 I l8 37 

1931-1932 16 27 

i93 2 ~ I 933 I0 J 8 

Total <?5 204 

The number varied each year with the needs of the New 
York and Smith College Schools, the number of students to 



26 TRAINING IN PSYCHIATRIC SOCIAL WORK 

whom one supervisor could give adequate training, and the 
changing policy of the Institute with regard to short-term 
students. In regard to the last point it was the experience of 
the staff that training during short periods must be kept on 
such a superficial level that it could be of little value to the 
average student. Therefore, after the first year a consistent 
effort was made to reduce the number of those who came for 
only one or two quarters. Another reason for limiting the 
number of short-term students was to minimize the turnover 
of personnel which is often a destructive factor in treatment. 
After June, 1929, therefore, only the student who was 
thought to have exceptional qualifications was accepted for 
one quarter of training, unless for any given quarter the 
quota from the New York School was not filled. 6 It was un- 
questionably true that many students did profit by this brief 
experience to a degree that could not have been anticipated, 
even by a staff intent on giving them a maximum return for 
their efforts. They were themselves usually aware of the dif- 
ficulties involved in such brief contacts with cases and were 
very cooperative with the staff in the effort to make their 
work as constructive as possible. 

We have been discussing as the minimum unit of training 
time the quarter, which lasted roughly twelve weeks. 7 How- 
ever, this does not correspond exactly with the amount of 
working time which the student put in during this period. 
There was a wide latitude in the amount of time any student 

6 In general more latitude was allowed in the acceptance of short-term students for 
the summer quarter, chiefly because few candidates from the New York School applied 
for three quarter training at this time and there were no Smith College School students 
during the summer. Also, the work of the Institute was somewhat atypical, with less 
emphasis on intensive work, because, among other reasons, many children were at 
camp, much work still had to be done in arranging for others to go, a large number 
of cases had been closed in June, and fewer new cases were accepted for treatment 
than during the rest of the year owing to the lack of long-time service available. 

7 For the Smith College School group, such quarterly divisions were made for pur- 
poses of convenience in statistical and other reporting by the Institute, although the 
school itself was not run on this quarterly plan, as was the New York School. 



THE TRAINING PROGRAM 



from the New York School might spend in field work in any 
given quarter, the range being from 2 to 5^ days a week. 8 
The number of days per week per quarter spent at the Insti- 
tute by students from the New York School in the year 1930- 
1931, shown in the following tabulation, is representative of 
the variation in time scheduled for field work for students 
from this school from October, 1929, to June, 1933, inclu- 
sive. 



NEW YORK 

SCHOOL 

STUDENTS 

10 

5 
I 

4 
I 
I 
I 
I 

2 

I 
I 
I 
I 
I 
I 
I 

I 
I 
I 
I 



DAYS PER WEEK, 1930-1931 



First 
quarter 

3 
5 

5/2 

3 
3 
3 



3 
3 
3 
3 
3 
3 
3 
3 

3 
3 
3 
3 



Second 
quarter 



3 
3t 

5/2 

5 
5 

3 
3 
3 
3 
3 



Third, 
quarter 



4 
5 

3 
3 
3 

4 



3 

3/2 

4 

4t 

5 

5/2 

4 
5 

3 
3 



* Some students worked a fourth quarter or part of it. 
f Did not complete quarter. 



fourth 
quarter* 



3 

4 

5/2t 
5/2t 



8 After October, 1929, no student was accepted for training at the Institute on the 
basis of less than three days a week. One hour weekly of the New York School stu- 
dent's time was allotted to the Institute staff conference. 



28 TRAINING IN PSYCHIATRIC SOCIAL WORK 

The four principal groupings of the New York School stu- 
dents in the years 1929-1933, by number of quarters they 
were in training and by number of days per quarter they 
gave to field work, are as follows: 

NEW YORK DAYS PER WEEK 1929-1933 

SCHOOL first Second Third 

STUDENTS quarter quarter quarter 

33 3 

22 3 3 

32 3 3 3 

13 3 3 4 

The largest group of students were in training for one quar- 
ter only and worked three days a week; the next largest were 
the three quarter students who gave three days a week to 
field work in each quarter. It will be seen from the tabula- 
tion that three days a week or 36 days a quarter was the typi- 
cal schedule at the New York School. 

All students from the Smith College School gave approxi- 
mately four days and one half a week to field work, not in- 
cluding time required for the work on their theses, for the 
one class held for these students only at the Institute concur- 
rently with their field work, and for the weekly staff confer- 
ence. It is in terms of the number of field work days that we 
shall in a later chapter attempt to estimate the volume of 
work in any given quarter. 

Some Vocational Aspects of Training 

The specific vocational aims of the majority of students 
were not as a rule very clearly defined. Some of them hoped 
to utilize their training in agencies similarly constituted, and 
to do a specialized job in psychiatric social work, but should 
no such opening be available, they would be ready to adapt 
the knowledge and skill obtained in this field to case work in 



THE TRAINING PROGRAM 29 

other agencies whose primary function was not psychiatric. 
Others with special interests in the fields of family welfare, 
child placing, visiting teaching, and so on, who came wishing 
to enrich their understanding of the motivations of human 
behavior and to refine their techniques of dealing with prob- 
lems of emotional unadjustment, found at the Institute not 
infrequently the impetus to specialize in mental hygiene work 
as practiced in psychiatric agencies. Still others had the con- 
viction that mental hygiene was making a most valuable con- 
tribution to case work in all fields, and that they definitely 
needed it as part of their case work equipment, although per- 
haps up to the end of their training they were uncertain as to 
the type of position to which they could best adapt their ex- 
perience. The flexibility of such attitudes was encouraged by a 
staff convinced of the generic nature of social case work, and 
of the fact that all work involving relationships with people 
requires an understanding of the causative factors underlying 
human reactions. 

The emphasis in training, then, may be said to have been 
placed on giving the students a background of experience 
which could be profitably adapted to any field of social case 
work. Every effort was made to develop in the students the 
security within themselves arising from a conviction of their 
ability to deal with the ordinary kinds of mental or emo- 
tional unadjustment in their clients. There was usually less 
effort made to help the one and two quarter students attain 
such an objective unless their own personality adjustment 
afforded exceptional qualifications for profiting by so brief a 
training period. The team work relationship provided by the 
child guidance clinic offered valuable preparation for work in 
a psychiatric agency 9 primarily, but in other types of agency 

9 Defined as one in which the minimum staff was made up of a psychiatrist and a 
social worker. 



3O TRAINING IN PSYCHIATRIC SOCIAL WORK 

as well. The worker who had profited at the Institute from 
collaboration with specialists in other fields was equipped to 
recognize in her case work in non-psychiatric agencies those 
problems which could be best handled by a psychiatrist or 
psychologist and should be referred to an agency in which 
such services were available. 

A survey made in 1933 of the positions held by former 
students gives some picture of the variety of fields into which 
they have gone, and the types of position, case work, super- 
visory, executive, etc., which they are now holding. The lists 
are incomplete, since some students were not heard fromj 
moreover, in consideration of the well-known frequency of 
turnover of personnel in social agencies, it is probable that 
some workers listed as holding a position in one type of 
agency, may have changed to another before publication of 
this report. However, the figures show that practically all the 
230 students whose records were available in 1933 were 
working, only 14 being unoccupied. The large majority (203) 
were holding positions in case work agencies, psychiatric, 
family welfare, child welfare, etc. Twelve were employed in 
non-case-working agencies and one in a commercial firm. 
Sixty-nine former students were holding executive or super- 
visory positions. 

Integration of Student Work with the Program of the Agency 

It is natural to assume that in about twelve weeks, which 
roughly constitute a quarter, considerable accomplishment 
may be expected. Even to informed and interested observers, 
such as board members of the agency and staff members of 
the schools of social work from which the students come, it 
might reasonably appear that in the first quarter, for ex- 
ample, a student should absorb a case load of 1 5 or 20 cases 
and that there should be a reasonable number of contacts, 



THE TRAINING PROGRAM 31 

perhaps one a week per case. If the volume of work is less, 
as an analysis of the records of the students in the Special 
Study Group would indicate, 10 it may seem justifiable to 
wonder what the students were doing and what the substance 
of their training was, since personal contacts with clients are 
essential to the integration of theory and practice. 

In Chapter VI some of the factors influencing size of case 
load and numbers of contacts exclusive of the students' abili- 
ties for carrying volume of work will be discussed. Further 
analysis of factors influencing volume of work is given in 
Chapter VII showing examples of individual students' reac- 
tions to the training situation as reflected in the amount of 
work carried by them. Here brief consideration is given to all 
the demands on student time exclusive of actual contacts on 
cases. Thus we shall have a complete picture of the training 
situation in this agency and the interrelation of all the factors 
influencing volume of work. 

In the first quarter, the student had to adapt herself to a 
larger staff than she had probably ever worked with before, 
to the unfamiliarity of the team work procedure, and to all 
the complexities of routine, such as making appointments, 
planning for typing, and routing material, inevitable in a 
large organization. All these unfamiliar types of activity, ex- 
clusive of direct contact on cases, made exacting demands on 
her time. Perhaps the most outstanding contrast with her 
former experience was the necessity to plan her time so as to 
make sufficient allowance for conferences. 

Because of the fourfold method of study and treatment 
approach, it was essential to relate at frequent intervals the 
case findings in each of the professional fields by means of 
consultations with the various members of the staff con- 
cerned. Such consultations may be classified as supervisory 

10 See chapter vi, tables 7, 8, n, and 12, pages 129, 131, 141, and 142. 



32 TRAINING IN PSYCHIATRIC SOCIAL WORK 

and group conferences. The latter included initial, treatment, 
and case work conferences} and weekly conferences on brief 
diagnostic consultation cases. 

There were on an average approximately one initial and 
one treatment conference 11 per student per month. These 
were the more formal type of conference scheduled from 
three to ten days in advance and attended not only by all 
members of the clinic staff who had worked on the case but 
often by other members of the staff. They were seldom fin- 
ished in less than an hour and lasted, on an average, an hour 
and a quarter. There is no way of checking the amount of 
time spent by the students on these conferences but it is 
probable that, especially in the first quarter, it took them at 
least two hours to do the necessary preliminary analysis of 
the case to be presented and to write up the summary. Besides 
the formal conferences there were a number of case work 
conferences each month. These were usually called to meet 
some emergency arising in treatment and consequently the 
number varied considerably. They were attended by a 
smaller group than the initial and treatment conferences but 
always by representatives from at least two fields social 
service and psychiatry, or social service and psychology, for 
example. Mention has already been made of the one-day 
diagnostic consultation service. In connection with this brief 
type of service, a consultation conference was held every 
week. The students were encouraged to attend these confer- 
ences frequently even when not themselves responsible for a 
case. 

There were also frequent consultations between student 

II The term initial conference is used throughout to designate the first conference 
held after the preliminary examinations on a case had been made in all four fields. 
The treatment conference was usually held at intervals of not more than three months 
during the period when the case was active. For further discussion of these conferences 
see chapter iv. 



THE TRAINING PROGRAM 33 

and psychiatrist or psychiatric fellow when the need arose to 
keep each other informed on the current situation. In a train- 
ing center where material before incorporation in the record 
was frequently subjected to reading and discussion by a staff 
member, the delays in making information available through 
dictation and routing of material were thus avoided. There 
was usually little or no preparation required for this latter 
type of conference or for the case work conference. 

All students were required to attend the general staff con- 
ference held weekly, usually presided over by the director, 
sometimes by the chief of staff or others, and attended by all 
the professional staff, permanent and temporary, including 
fellows in psychiatry and psychology and social service stu- 
dents. At these conferences a variety of programs was pre- 
sented. To quote from one of the director's reports: 

During the first year the discussions were chiefly on individual 
cases, particularly those showing blocks in progress. In succeeding 
years the program varied somewhat, there being more discussion of 
general matters, such as history of evolutions within the field of 
mental hygiene, examinations and treatment techniques, interview- 
ing, and specific case discussions. In 19291930 one meeting a 
month was given over to a discussion, by an authority in the field, of 
various types of effort in the schools and social agencies. In addition, 
special visitors who have been at the Institute at the time of such 
staff meetings have been invited to talk to the staff group. The at- 
tempt was to have the general staff conference as nearly as possible 
an open forum for discussion within the area being explored at the 
time. 

Two hours a week were made available to the student for 
discussion with her supervisor, and often this period of con- 
sultation was extended, since it was found all too brief for 
adequate consideration of the social psychiatric implications 
in the material. The necessity for allowing sufficient time for 



34 TRAINING IN PSYCHIATRIC SOCIAL WORK 

supervisory conferences is obvious since this is the most im- 
portant medium that has been established in the training 
process through which the student may achieve for herself, 
within the limitations set by her own readiness for this ex- 
perience, the maximum integration of her theory and prac- 
tice. 

Time spent by the students in taking application interviews 
and in attending meetings of the referral committee has al- 
ready been mentioned. Reading and analyzing case material, 
recording, and traveling to and from interviews consumed 
many hours. Making summaries of material to be presented 
at conferences undoubtedly raised the total number of hours 
spent in recording. 

Many students were slow to recognize the importance of 
such full recording as was required at the Institute, where 
emphasis was placed on the genesis of emotional attitudes 
and responses, and for this reason time spent in recording was 
protracted by conscious or unconscious resistances which were 
only worked out gradually during the training process. Other 
students experienced great difficulty, particularly in the early 
period of their training, in clarifying for themselves what 
the pertinent material was which should be included in a 
record. As a rule, this ceased to be a problem as the student 
became more secure in her grasp of social psychiatric concepts 
and in her ability to apply them. The difficulty that many 
people find in expressing themselves in writing must also be 
taken into account, perhaps more often slowing up the work 
of the older students who were further removed from the 
academic background of college or university with its rou- 
tine of class papers, term papers, theses, etc. To them, or- 
ganizing the material of the relatively long and detailed so- 
cial examinations and preparing reports for discussion were 
often particularly difficult and the technique was only slowly 



THE TRAINING PROGRAM 35 

achieved. The time spent in recording, then, varied widely 
with the individual as did the time spent in case reading and 
analysis, since these activities were even less controlled than 
others by the standards set by other students or by the clinic 
routine. It was, however, an essential part of the supervisor's 
responsibility to attempt to keep track of the time spent by 
each student in recording and analyzing case material and to 
help her keep this within reasonable limits. 

In a large metropolitan area like New York City a good 
deal of time must of course be consumed in traveling from 
place to place. Every effort was made at the Institute to re- 
duce transportation to a minimum, first, by generally limiting 
cases which could be accepted for treatment to those who 
lived within forty minutes of the Institute, and second, by 
assigning to each student, as far as possible, cases within the 
same geographical area. 

The hours spent in training activities during the year 
1 93 i~i 932" have been averaged from the students' record 
sheets and are presented in Tables I and 2. The time allowed 
the Smith College School students for work on their theses, 
four hours a week, is not included in the table. If this is de- 
ducted from their 38^ hour week, 13 34^4 hours are left for 
all other activities, considerably more than is recorded in 
Table i for any of the three quarters. It must be assumed, 
therefore, either that time was inaccurately recorded or that 
more time was spent on thesis work, during this year at least, 
than had been allowed for in administrative planning. A cer- 
tain amount of time spent on such routine matters as making 
appointments, getting records, consultation with the steno- 
graphic department on typing and routing of material, etc., 

12 This was the first year that a routine account was kept of the time spent on each 
type of student activity, although previous to this a record was drawn up periodically 
from student logs. 

13 This is reckoned on the basis of a $J^ day week and a 7 hour day. 



36 TRAINING IN PSYCHIATRIC SOCIAL WORK 

is not accounted for in the tables. It would not be possible to 
estimate with any degree of accuracy what the average time 
spent in this way would be, although it was presumably less 
than an hour a week. 

The group of New York School students on whose work 
the figures in Table 2 are based were at the Institute three 
days or 2 1 hours a week during the three quarters of their 
training. In comparing the total number of hours reported in 
the three quarters with this figure, it will be seen that a small 
amount of overtime is recorded in the first two quarters and a 
large amount in the third quarter. Despite the most conscien- 
tious intentions, there was undoubtedly so much variation in 
the accuracy with which individuals kept account of time that 
these averages cannot be considered reliable. It was certainly 
true, as the supervisors knew from personal observation and 
from deductions based on the amount of work accomplished, 
that the overtime for many students from both schools was 
very high. It will only be possible, therefore, to consider 
these figures as a rough approximation of the time spent by 
the students. 

It will be noted that for both groups of students the time 
spent on direct contacts with cases, listed in the table under 
Interviewingy was small in proportion to the sum of the time 
spent on related case work activities, and that the number of 
hours under Recording was consistently higher for both groups 
in all three quarters than that for other activities. In view of 
the many and varied demands on the students' time in a clini- 
cal organization of the Institute's type, it is perhaps not re- 
markable that interviewing time bulks so low in relation to 
the whole. It is not known how comparable this distribution 
of time may be with that in other psychiatric agencies where 
students receive training, so that it is difficult to decide 
whether it may be considered reasonable. 





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Ill 

UTILIZATION OF CASE MATERIAL 
IN TRAINING 



CASE work at the Institute was to some extent slowed up 
because most of the active therapy was carried by the 
students in social service and the fellows in psychiatry. Yet 
even such limitations were susceptible to modification and 
were perhaps no greater than those due to other causes in 
agencies which did not carry so extensive a training program. 

In order to facilitate absorption by the agency of a greater 
case load various expedients were utilized. For example, 
more cases were assigned to students in social service to be 
carried as their major responsibility, thus relieving the psy- 
chiatrists, as they approached the saturation point of cases 
they could carry adequately, of the need of the active partici- 
pation required when the responsibility was shared equally 
by psychiatrist and social worker or when the responsibility 
was carried chiefly by the psychiatrist. Further increase in 
case load was made possible by the clarification of criteria for 
closing cases at the earliest possible point commensurate with 
adequate case handling. Greater discrimination was increas- 
ingly exercised by the individuals responsible for acceptance 
of cases in the selection of problems suitable for treatment 
through the social psychiatric approach. This was another 
factor of the greatest importance in minimizing the possi- 
bility of clogging the students' assignments with unprofitable 
material. 

Discussion of the philosophy and techniques of case 
handling evolved through the years of the Institute's experi- 



4O TRAINING IN PSYCHIATRIC SOCIAL WORK 

ence is not seen as having a place within the scope of this 
study. Brief reference to this will be made from time to time 
since some orientation to the individual emphasis on case 
work characteristic of the Institute is considered essential to 
the understanding of the training program, of which it is an 
integral part. 

Case Load 

The degree to which intake of cases was influenced by the 
training needs of the agency is difficult to evaluate. It is 
probably fair to say that the effect was small because of the 
underlying philosophy of the staff that any case suitable for 
treatment is potentially productive of training values, and 
that the interests and needs of all cases, with rare exceptions, 
may be protected and met in a situation where those in train- 
ing are working on cases in consultation with staff members. 
The amount of service time available in any one of the pro- 
fessional fields served to slacken case intake at one time, and 
to expedite it at another. This would be true to some extent 
in any psychiatric clinic, although in a training center it is 
necessarily a more serious problem. That a definite perio- 
dicity in such fluctuation could be counted on at the Institute 
because of the regular turnover of workers in training, was 
obviously a factor to be faced and handled with as little cause 
for discomfort and irritation to the patients, their parents, 
and referring agencies as possible. In spite of certain difficul- 
ties in balancing intake and personnel, on the whole, supply 
and demand were found to be fairly adjustable. 

The degree to which case closing was influenced by the 
training situation is probably easier to appraise. The large 
proportion of cases in which treatment was terminated just 
prior to the largest student exodus in June is indicative of this 
interrelation, although it is true that changes in school and 



UTILIZATION OF CASE MATERIAL 4! 

family plans, often resulting in fewer contacts with parents 
during the summer, are also responsible for the tendency to 
close cases at this time. The closing of a case sometimes coin- 
cided with the departure of a student who had participated in 
treatment because the careful analysis occasioned by a shift in 
workers revealed that from a therapeutic standpoint the case 
was ready for closing. In probably relatively few instances 
this might have been recognized sooner if as careful an 
evaluation had been practicable at an earlier stage in treat- 
ment. 

An effort was made to determine those inherent factors in 
a case which would recommend it for treatment or which 
would make the possibility of improvement so doubtful that 
it would seem unwise to accept the application. Experience 
showed, however, that it was impossible to find any criteria 
that could be generally applicable and the question who 
might profit from treatment had to be decided each time in 
the light of the individual's personality and environment. 1 
On the whole, the cases which offered the most favorable 
prognosis were those of children whose parents understood, 
at least in broad terms, the sort of help that the agency was 
equipped to give, and were receptive in their attitude toward 
it, or, in other words, where there did not seem to be serious 
discrepancy between what was sought and what was available 
in service. The cooperation of the children was obviously es- 
sential when direct work was to be done with them. It was 
possible to determine almost at once the attitude of the par- 
ents since at least one parent or parent substitute was ordi- 
narily interviewed when the application was received. 2 With 

1 An extremely interesting survey representative of some of the most advanced 
thinking on this whole subject of criteria of treatability in cases will be found in The 
Dynamics of Child Guidance y by Dr. Marion E. Kenworthy, about to be published. 

2 Exceptions to the rule of interviewing parents or parent substitutes may be found 
in the procedure with regard to cases accepted on a consultation basis from other 



42 TRAINING IN PSYCHIATRIC SOCIAL WORK 

the exception, then, of the special case which seemed to pre- 
sent a combination of destructive factors, making prognosis 
for treatment too poor to justify acceptance, the Institute was 
prepared to meet the needs of any child up to eighteen years 
who showed actual or potential difficulties of emotional ad- 
justment. Such problems in adjustment might be evident 
either in his own symptomatic behavior or through the par- 
ent's conscious or unconscious relationship to him. Malad- 
justment was usually shown by a tendency on the part of the 
child to withdraw from the reality situations of everyday life 
and to build up an unhealthy world in which he could relive 
in phantasy satisfactions belonging to the more protected pe- 
riod of infancy or earlier childhood 5 or by a tendency to 
project dissatisfactions on to the environment by fighting, 
teasing, disobedience, truancy, and other aggressive manifes- 
tations. 

Problems to the solution of which the agency had nothing 
to contribute that might not be obtained from other existing 
community facilities were those of immediately recognizable 
feeblemindedness and epilepsy, uncomplicated by severe 
emotional and environmental maladjustment. However, if it 
was thought that an adjustment of the individual to the com- 
munity might be brought about by some resolution of the 
emotional problems involved, a case of feeblemindedness or 
epilepsy might be accepted. 

The need for different types of treatment service was 
often indicated in the application interviews, and certain 
types of service were established to meet these needs as effec- 
tively and economically as possible. Within the two general 
types of service given, consultation and treatment routine, 

agencies. In such cases the treatment responsibility was carried by the referring agents 
to whom our contribution, based on the result of clinic findings, was as far as pos- 
sible within the area in which they felt the need of reinforcement or advice. 



UTILIZATION OF CASE MATERIAL 43 

there was specialization to meet the needs represented by cer- 
tain groups of cases. 

An advice case was usually seen only by the social service 
staff member carrying responsibility for applications. When 
it seemed that advice from another professional source would 
also be helpful, members of the staff in other fields were 
sometimes asked to interview the applicant. Such situations 
were sometimes handled by students, as part of their experi- 
ence in taking application interviews. Since it was not always 
possible to predict when advice cases would present them- 
selves, occasionally the students ran into them without prepa- 
ration. Whenever it was possible to plan for such assignments 
in advance, they were made at that point in training when 
students might be expected to handle them most adequately 
and gain most from them. 

The staff social worker responsible for applications as- 
signed cases to the clinical units in consultation with the staff 
members of each unit. The cases were then assigned in turn 
to workers in the four professional fields within the unit. If 
the workers were students or fellows, the cases were carried 
by them in consultation with staff members. 

A brief analysis of the case load carried at the Institute 3 
during a typical year will clarify further the training situa- 
tion. Figures taken from the annual records of the Institute 
for the year ending June, 1932, are reasonably typical of the 
yearly volume of cases carried and sources of application. In 
this year there was a total of 718 accepted cases open some- 
time during the year. Of these 342 were old cases brought 
forward from the previous year, 337 were new cases, and 39 
were closed cases reopened. Five hundred and fifty-seven 

3 For full discussion of case load, sources of applications, age and sex of cases, see 
Institute for Child Guidance, Lawson G. Lowrey, M.D., and Geddes Smith (New 
York: The Commonwealth Fund, 1933). 



44 TRAINING IN PSYCHIATRIC SOCIAL WORK 

cases were closed during the year. The term "new" was ap- 
plied to cases just accepted for some type of treatment serv- 
ice and on which workers assigned made the first contacts ex- 
cept the application interview. The term "old" was applied 
to cases at the time they were reassigned to a different worker 
or workers than those who had initiated treatment. Many 
subsequent reassignments might be made during the time the 
case was active. Closed cases were those on which the period 
of contact with the clinic either had terminated, or was to be 
suspended for several months: e.g., a number of cases were 
usually closed during the summer quarter to be reopened in 
the fall, if a follow-up visit at that time suggested the advis- 
ability of such procedure. Reopened cases were those on which 
treatment became active after the status of closed case had 
been assigned. Such cases included those closed without treat- 
ment as well as those on which there had been previous treat- 
ment. 

Of the 492 new cases applying from June I, 1931 to May 
I, 1932, the largest proportion, or 33.7 per cent, were re- 
ferred by parents or relatives. Agencies referred 32.1 per 
cent ^ schools, 14.0 per cent. The remainder were referred by 
physicians and other persons or organizations. Ordinarily 
cases referred by case work organizations which were still 
active in the situation were given the one-day diagnostic con- 
sultation service only, the referring agency continuing to 
carry the responsibility for treatment. (See Chapter II, page 
20.) 

Case Assignment to Students 

Many of the students came to the Institute with the pre- 
conceived idea that at last they had found an ideal setting a 
clinic with a limited intake and that therefore they would 
be able to work with relative leisure on a few cases only. 



UTILIZATION OF CASE MATERIAL 45 

They soon found that this was by no means the actual situa- 
tion. With the exception of the first year, when the Institute 
was getting under way and the total case load was small, 
there was up to the last year, which again was atypical, a 
large active load of cases for reassignment to each incoming 
group of students. New cases were also assigned to them at 
an increasingly early point in their training in each succeeding 
year, because of the growing emphasis the staff put on the 
value of introducing this type of experience at the earliest 
point commensurate with the students' ability to handle it. 

Students were expected to carry all types of cases: those 
needing intensive treatment} those receiving short service 
only, or those on which treatment was to be continued on the 
basis of relatively infrequent contacts until the situation was 
sufficiently stabilized to justify closing j and those on which 
few contacts were to be made by social service, the major re- 
sponsibility being carried by the psychiatrist or the psy- 
chologist. 

In other words, the student was responsible from the start 
for a variegated and relatively unselected case load, similar 
to that which she would ordinarily find in any future job. 
Neither was she relieved from the occasional need of meet- 
ing emergencies, nor from doing night work, any more than 
she would have been as a salaried worker. While an effort 
was made to arrange the students' programs and coordinate 
their activities so that they should have the opportunity to 
carry a certain number of cases in intensive treatment, the 
case work needs of the agency as a whole were given first 
consideration. It may therefore be said that case assignments 
were controlled indirectly by the needs of the student but di- 
rectly by the needs of the agency. 

Some of the specific values of this plan were: first, the stu- 
dents sained more quickly a feeling of identification with the 



46 TRAINING IN PSYCHIATRIC SOCIAL WORK 

staff, because they assumed responsibility for clinic case load 
on the same terms as staff workers and were not treated as 
members of a protected and specialized group ; second, they 
were released at the start from the theoretical concept, com- 
mon to many workers in other fields, that all cases in a psy- 
chiatric clinic are subjected to the same kind of exhaustive 
examination and treatment irrespective of the needs of the 
individual patient; and finally and of greatest importance, as 
a corollary to the above, they were helped to realize that the 
needs of the case and the obligation to work out ways of 
meeting them most adequately were the chief concern of the 
entire clinic group of which they were part. Although this 
last objective was not always accomplished at an early point 
in the students' training, if indeed at all in some instances, it 
was not because the staff failed to recognize and to emphasize 
the claims of the reality of the situation. When a student was 
able to accept and integrate into her own thinking this funda- 
mental concept of clinic philosophy, there was often a 
marked and rapid shift from self-conscious preoccupation 
with her own limitations to more objective interest in de- 
veloping a dynamic and creative approach to the case situa- 
tions with which she was dealing. In such instances the de- 
manding attitude toward the staff, which arose from the stu- 
dent's own insecurity, tended gradually to resolve and a more 
mature attitude was evidenced by her acceptance of her limi- 
tations as perhaps necessarily greater in degree at this point, 
but not essentially greater in kind, than those she sensed in 
the more experienced staff workers. 

The trend in Institute policy to assign to a student an in- 
creasing number of cases in each quarter of her experience is 
reflected in the statistical records for the years 1930-1932. 
It was commensurate both with the expanding case load of 
the agency and with the growing conviction on the part of the 



UTILIZATION OF CASE MATERIAL 47 

staff that training should offer a situation approximate in 
every way to the realities of a salaried position. It was, of 
course, recognized that even the maximum case assignments 
in an agency like the Institute would be small in comparison 
with those of psychiatric agencies subsidized by public funds 
and working under the pressure of heavier demands from 
the community. In the years 19301932, when the policy of 
increasing case load was put into effect, the average number 
of cases carried per quarter for three quarters was as fol- 
lows: 4 

First quarter Second quarter Third quarter 

10 15 18 

Although it is not possible to generalize, since the training 
program was consciously kept flexible in order to meet indi- 
vidual needs and abilities, we may say that in the first quarter 
ordinarily the plan was to assign a fairly large number of 
cases which would afford an opportunity for a scattering of 
contacts on a fairly superficial level. Such a relatively super- 
ficial approach often was all that the students 5 understanding 
at that time made possible. In the beginning, then, the stu- 
dents were more exclusively concerned with analyzing cause 
and effect relationships as reflected in the behavior of patients 
and their families, and dealing with these problems on a less 
intensive level than ordinarily was true of their approach 
in the latter months of their training. As fast as they gave 
evidence of being better equipped to utilize a therapeutic ap- 
proach leading to changes in emotional attitudes on a more 
fundamental level, they were free to attempt this. 

4 These figures represent averages of size of case load carried by students from 
both schools in the Special Study Groups. (An analysis of the work of the Special 
Study Groups is made in chapter vi.) The students in these groups were selected 
solely on the basis of having spent periods of time in training that were as nearly 
comparable as possible, given the wide variations in the time element in training. 



48 TRAINING IN PSYCHIATRIC SOCIAL WORK 

Training Value of Case Material 

One point which was of special interest in relation to the 
training of the social service students, was the large number 
of cases carried over from one year to the next (see page 43). 
It was this group of old cases, which had been under treat- 
ment some for a few months only, others for a period of 
from one to five years or longer on which most difficulty 
was found in stimulating students' efforts to continue work. 
Although the inexperienced workers as a rule did not object 
to having the usual number of old case assignments, often 
constituting as much as two thirds of their whole case load, 
the experienced workers expressed considerable dissatisfac- 
tion on this score. The feeling was that these cases afforded 
little stimulus to the students' interest and efforts because 
prognosis of success seemed to them doubtful. Among the 
reasons given why the chances for improvement were slight, 
the following were the most usual: the frequent turnover in 
workers had constituted an obstacle to treatment ; the previ- 
ous worker, psychiatrist, or social worker had mishandled the 
situation; the case had been so mulled over in conferences 
that all constructive leads had been exhausted; and finally, 
in some cases treatment had been blocked from the start by 
the emotional maladjustment of the parents whose drives 
could only be satisfied at the expense of the patient. 

While it was the exceptional student who was sufficiently 
well grounded in psychiatric theory to feel secure in making 
the last criticism in just those terms, her insight or intuition 
into the mechanisms operating in the case, often expressed 
naively by the statement that the parents were "hopeless," 
was sometimes sound although others had not recognized 
the impasse. Failure to perceive the hopelessness of the situa- 
tion might occur when someone of the clinical group had 
fallen into the very human error of permitting himself an 



UTILIZATION OF CASE MATERIAL 49 

emotional stake in carrying a case through to a successful ad- 
justment, which kept him from detaching himself sufficiently 
from the situation to make an objective evaluation. Granting, 
however, that such lack of objectivity did occasionally exist, 
and undoubtedly always will to some degree in any clinic, it 
is reasonably certain that the large majority of the old cases 
were treatable. This was true because of the potentialities for 
constructive adaptation which were inherent in the patient or 
his family, or both, at the time the case first came to the at- 
tention of the clinic and because in the interval between that 
time and the assignment to date the treatment had been on a 
sufficiently constructive level to make the prognosis for im- 
provement a sound one. Since the problem of seeing any con- 
structive approach to old cases continued to exist for the stu- 
dent, however, no matter what the reality situation may have 
been, the supervisor was challenged somehow to discover a 
means of making the old case material more dynamic. Dif- 
ferent methods were used by different supervisors, and by 
the same supervisors with different students, but as far as we 
may judge from the reports of individual students at the end 
of their training experience, it was the exception rather than 
the rule to find that any of the methods utilized were com- 
pletely successful. 

Certain students found it more stimulating to their inter- 
est to make a rather thorough evaluation of the constructive 
and destructive factors in the treatment relationships up to 
the point where they took the case over. This procedure 
seemed to them to point up the issues and to challenge their 
resourcefulness and their ability to inject into their treatment 
approach all the constructive elements possible. Other stu- 
dents looked upon this analysis as a dry academic exercise, 
and failed to see how it could be made vital until they had 
themselves established contact with the family and had de- 



5O TRAINING IN PSYCHIATRIC SOCIAL WORK 

veloped a feeling of identification with it on this direct basis. 
Still others saw little value in such treatment evaluation until 
after they had worked on the case for two or three months, 
long enough to take stock of what they had been doing in 
terms of the case situation as a whole. The relatively objec- 
tive picture thus obtained of the causes underlying their suc- 
cesses and failures seemed to provide a basis for the healthy 
self-criticism essential to a sense of professional adequacy 
and security at this time. 

To many students, perhaps to all, apparently the most 
universally successful method of stimulating interest in old 
cases was, paradoxically enough, the assignment of a new 
case. It appears from the students' own comments that the 
whole process of dealing with their own first new case was so 
stimulating to their thinking and to their acceptance of the 
case work policies of the Institute that it affected their atti- 
tude toward their entire case load. For this reason, after the 
first year a consistent effort was made to assign a new case to 
each student within the first month of her arrival, and to fol- 
low this up with another new case as soon as possible. Often 
early contact with new material was afforded through the as- 
signment of a consultation case, as well as a case for treat- 
ment. 

While the one-day diagnostic consultation service cases, 
described elsewhere (see Chapter II, page 20), furnished the 
student with one of the most dynamic sources of contact with 
the personnel of other agencies, and thus with the means of 
understanding the philosophy and working methods of these 
agencies, all types of cases were to some degree productive of 
these values. The large proportion of cases referred to the 
Institute by agencies has already been noted (page 44). Other 
agencies were utilized in treatment, while still others then in- 
active had been sources of help to patients or their families at 



UTILIZATION OF CASE MATERIAL 5! 

some period before they came to the Institute. It was ob- 
viously not necessary for a student worker always to make a 
contact with every agency to which a case had been known, 
but in many instances there was sufficient opportunity for 
give and take with other agencies to make possible a better 
understanding of the client's past associations and to afford 
the groundwork for smooth and effective reciprocal relation- 
ships in future practice. It was recognized, however, that in 
a large city like New York, with its multiplicity of social 
agencies scattered over the wide metropolitan area, it is diffi- 
cult to achieve the real familiarity with the identity and 
"f eeling tone" of an organization, arrived at more naturally 
and simply in the closer association afforded in smaller com- 
munities. Perhaps in view of the actual situation as much as 
possible was done, by utilizing all the opportunities presented 
by case contacts, to make the students aware of the impor- 
tance of easy inter-agency relationships. However, particu- 
larly to students who had never before worked in New York, 
this aspect of case handling must sometimes have seemed 
difficult and not altogether satisfying. 

At one point early in the Institute work, analysis of school 
referrals revealed that approximately 300 cases were re- 
ferred by 148 public schools, or, on an average, two cases per 
school. This suggests how difficult it was to establish valuable 
working relationships with schools. The student often had to 
be the organization's emissary in making the first contact in 
a particular school, and in interpreting the Institute's func- 
tions and purposes. 

With some students who had been closely concerned with 
other fields of social work before coming to the Institute, a 
tendency to overidentification with other agencies, particu- 
larly with those of the kind with which they formerly were 
associated, was sometimes noted, showing that they had not 



52 TRAINING IN PSYCHIATRIC SOCIAL WORK 

yet arrived at a point where they were ready emotionally to 
accept the concepts underlying social psychiatric practice. To 
such students it was often found helpful in the earlier period 
of training to assign as far as possible cases in which few 
agency contacts were indicated. 

After the first year, the experiment was tried of giving the 
students some experience in handling applications. In this 
way, they had the opportunity to make the initial contact 
with the patient and the artificial barrier between worker and 
client, sometimes caused by having one person take all appli- 
cation interviews, was not built up. They also could learn to 
appreciate why in general it was important, as an administra- 
tive procedure, to assign applications to one person, who 
through concentrated and continuous experience might de- 
velop special ability in determining treatability and type of 
service required. Responsibility for the application interviews 
helped to broaden the students' perspective by making it neces- 
sary for them to decide what type of problem 1 could be bene- 
fited by the psychiatric clinic and what resources were available 
for cases not accepted for treatment. It also provided oppor- 
tunity for experience in an administrative function of major 
importance at the Institute. The experiment seemed to be of 
sufficient value to recommend it as a permanent part of stu- 
dent training and was continued until the closing of the In- 
stitute. The amount of time given to application interviews 
differed considerably at different times and with different 
students. In some instances it was possible to assign to the 
student as a part of her regular case load the case on which 
she had taken the application interview. 

The need for a variety of problems in the cases carried by 
students is often stressed by supervisors and others respon- 
sible for training. It is true that this has a certain value in 



UTILIZATION OF CASE MATERIAL 53 

enriching the student's experience. Too often in the past, 
however, there seems to have been a tendency to think of 
"variety" in terms of problems that seem to a beginning stu- 
dent to fall easily into different categories or groups, such as, 
for the patient, lying, stealing, revolt against authority, day 
dreaming, masturbation, and so on; and for the family, 
financial insecurity, dominant, aggressive attitudes of parents 
toward their children, marital disharmony, rejection of chil- 
dren by step-parents, etc. This tendency to dramatize a situa- 
tion in terms of one outstanding symptom of maladjustment 
may easily insinuate itself into the thinking of those handling 
a case with the result that they may tend to focus treatment 
approach consciously or unconsciously on the resolution of 
this particular aspect of the problem. Under these conditions 
there is often a serious lack of discrimination in evaluating 
the true causes of the individual's unadjustment. 

Without insight into the factors underlying temper tan- 
trums, for example, the beginner may make serious blunders 
in handling the treatment relationships. Too frequently the 
student, interpreting this behavior as that of an over-indulged 
child, without recognizing the fact that symptoms of this 
sort may also appear in a child who has been rejected instead 
of over-indulged, attempts to lead the parents to an emo- 
tional acceptance of the value of ignoring the symptoms. 
Such a procedure would obviously produce further depriva- 
tion for a child who is striving by display of temper to gain 
some response or concern in a setting in which he finds him- 
self deprived of affection. When as a result of this sort of 
handling the child's drive for attention becomes intensified, 
the student will usually become aware of an alarming tend- 
ency on the part of the parents to reject him openly. The 
belated realization that she has helped to reinforce the ele- 



54 TRAINING IN PSYCHIATRIC SOCIAL WORK 

ments originally operating to disintegrate the parent-child 
relationship is one of the destructive experiences to which no 
student need be exposed. 

As seen in retrospect, then, the growing trend in Institute 
philosophy to minimize the importance of symptoms in as- 
signment of cases to students and to consider that any case 
potentially rich in possibilities for readaptation was of value 
for training would seem to be a healthy one. It became in- 
creasingly clear that an early appreciation by the student of 
the dynamics involved in human behavior was most impor- 
tant, and therefore emphasis was placed upon her considera- 
tion of these mechanisms. An attempt was made to give the 
student understanding of the different ways individuals uti- 
lized their reality experiences and thus to direct their atten- 
tion to a most fruitful area for study and for growth in hu- 
man understanding. There was also at times a very real value 
in giving a student at least one case in which the social and 
cultural standards were superior, in order that she might 
have the opportunity for identification with individuals 
whose background was more nearly like her own. Such situa- 
tions were rich in opportunities for growth, since the student 
through her identifications with these individuals was often 
helped to a more ready acceptance of her own limitations and 
to a tolerance for others who, in spite of so-called "advan- 
tages," were having difficulties in their emotional adjust- 
ment. 

The ability on the part of the student to profit by her rela- 
tionships with her clients was obviously the crux of the whole 
training situation. To some students, always, everything is 
quickly utilized as "grist to the mill" in terms of opportunity 
to explore the intricacies and seeming contradictions of hu- 
man behavior and to grow through this in understanding of 
themselves and others. To others, who are slower to recog- 



UTILIZATION OF CASE MATERIAL 55 

nize such possibilities, help may be given by the supervisor 
in the emphasis placed at certain periods of training, on the 
assignment of new versus old cases, consultation or treatment 
routine case material, the handling of relationships with 
other agencies, and so on. Perhaps generalization is justified 
to this extent: for all students it has seemed important con- 
sistently to increase the size of the case load as fast as they 
could absorb and profit by such increase, in order to broaden 
and enrich their experience through identification with many 
individuals. 

Division of Case Responsibility 

Out of the entire body of 289 students in training during 
the years 19271933 only a few had had previous psychi- 
atric clinic experience. For the students who lacked this ex- 
perience, adjustment to working in a team work relationship, 
and especially to close cooperation with the psychiatrist, was 
not infrequently difficult. This was perhaps most often true 
of the students who came to the Institute after years of case 
work in other fields, habituated to carrying practically full 
responsibility for their cases, particularly if this previous ex- 
perience had been very satisfying emotionally and intellec- 
tually. This problem, like all others arising in the training 
process, was handled on an individual basis. 

Often for the student the process of making the social 
study available and valuable for others as well as for herself 
and the subsequent discussion of this at the initial conference 
brought about a synthesizing of information and points of 
view which led to a more complete understanding of all the 
issues involved. This understanding sometimes made possible 
her acceptance for the first time of the use of the fourfold 
approach in the study of the case. Even at this point, how- 
ever, her impulse was often to see the value of the group 



56 TRAINING IN PSYCHIATRIC SOCIAL WORK 

effort merely as a reinforcement of her own position in her 
subsequent treatment of the case and to discount the necessity 
for active participation by other members of the staff. The 
succeeding steps by which the student was led to a more com- 
plete acceptance of the value of sharing responsibility with 
the psychiatrist are not apparently as clear as this initial one. 
Theoretically, the transition was made more readily if a few 
of the student's cases, especially those most dynamic in treat- 
ment possibilities, were given psychiatric treatment by a staff 
psychiatrist rather than by a fellow. Since the psychiatric fel- 
low was as unfamiliar in general with team work procedure 
at the start of his training as the student herself, and was as 
uninformed as she in the adaptation of psychiatric theory to 
child guidance work, it might be expected that she would 
feel reluctant to work with him. However, actually the fel- 
low often proved as helpful in getting the student to share 
responsibility for a case with him as the psychiatrist. To many 
of the students not altogether objective in their outlook, the 
ability to identify with the philosophy and techniques of a 
worker in another field, and as a result to profit by his con- 
tribution, often depended on the personality of that profes- 
sional worker rather than on his experience or maturity. It is 
not possible, therefore, to make any generalizations as to the 
relative value of working with the staff psychiatrist or the 
fellows, although it is safe to say that ordinarily any substan- 
tial contribution derived from work with the fellows neces- 
sarily came toward the end of their training. While certain 
students had the need to reject the participation of the psy- 
chiatrist in their cases, others were all too ready to project 
the major part of the responsibility for all their cases on him, 
and to subordinate themselves to the kind of errand girl role 
characteristic of the embryonic period of psychiatric social 
case work. Some students, who exhibited such dependency 



UTILIZATION OF CASE MATERIAL 57 

needs, found in the psychiatrist with whom they worked the 
ideal parent image which they were unconsciously seeking, 
and accepted his work completely and uncritically. On the 
contrary, other students whose need for dependency was not 
so marked were disappointed to find that psychiatric practice 
like all other phases of work in an organization where much 
of the case work was carried by those in training, was at best 
uneven and very seldom measured up to the somewhat ex- 
aggerated ideas they had previously held of what could be 
accomplished through the mental hygiene approach. It was 
often found possible to forestall such disillusionment by em- 
phasizing, in the early days of the training period, the fact 
that the process of changing human attitudes, which are 
rooted in the individual's previous life experiences, is neces- 
sarily accomplished slowly through gradual growth, and that 
the permanency of sudden and spectacular success is often 
open to question. In addition, it was frequently necessary to 
face frankly with the student the unevenness of work implicit 
in any training situation. Both to the students who showed 
a need to reject the contribution of the psychiatrist, and to 
those who showed a need to become too dependent upon it, 
the very fact that many of the fellows in psychiatry were no 
better prepared than they were themselves to shoulder the 
major responsibility for a case, may have been helpful rather 
than otherwise. In this situation the student's attitude toward 
the division of therapeutic responsibility may be the more ob- 
jective because she feels less insecure as she senses the limita- 
tions of the psychiatric fellows in the early period of train- 
ing. They may then find themselves able to accept the con- 
tribution of the fellow on a cooperative basis, without the 
earlier elements of competitiveness or dependency. 

It was not practical to keep a running record of the divi- 
sion of treatment responsibility in the Institute case load, 



58 TRAINING IN PSYCHIATRIC SOCIAL WORK 

since frequent shifts were made necessary by the changing 
needs of the cases. Such changes were also imposed, but to a 
much less extent, by the strength of service and amount of 
time available in each of the professional fields for cases 
needing special handling. The figures in the following tabu- 
lation represent one small cross section of the total situation, 
based on a survey made of the cases in April, 1931. They are 
probably reasonably typical, and give some picture of the ex- 
tent to which a student had the opportunity to handle cases 
for which a psychiatrist or psychologist carried the major re- 
sponsibility, as well as the extent of her experience with cases 
in which the major responsibility rested with social service, or 
in which responsibility was shared with the psychiatrist or 
psychologist. 

DISTRIBUTION OF CASE RESPONSIBILITY FOR 28 I CASES CARRIED 
BY STUDENT SOCIAL WORKERS ON A GIVEN DAY 



Total cases under treatment April 15, 1931 
Major responsibility for case work in one field 

Psychiatry 

Psychology 

Social service 
Joint responsibility in two or more fields 



Number 

of cases 

281 

3 1 

5 
72 

173 



Percentage 

distribution 

IOO.O 

I i.o 

1.8 

25.6 

6l.6 



IV 

GROUP CONFERENCES ON CASES: 
TRAINING VALUES 



MENTION has already been made of the value to the 
student of the group conference as a means of facili- 
tating cooperation with other professional workers in plan- 
ning and carrying out treatment processes. Such conferences 
had further specific training values in contributing to the stu- 
dent's assimilation of mental hygiene concepts and to the 
clarification of case work techniques and approach. In addi- 
tion they frequently contributed to the solution of a student's 
difficulties in accepting the student role in relation to her su- 
pervisor. 

Discussion of case issues by the group often released the 
student from the feeling that she had to rely on her super- 
visor alone for help and as a result whatever negative or un- 
satisfying elements there were in the supervisor-student rela- 
tionship for her were modified. Also the student, through 
group conference discussion, would frequently grow in her 
understanding of the causes underlying the behavior and atti- 
tudes of the clients which had formerly seemed obscure or 
overdrawn to her. However, the relationship between such 
acceptance of concepts and acceptance of supervision is nei- 
ther inevitable nor always defined, and anything like a full 
acceptance of the training situation or the subject matter of 
training is unquestionably a long growth process for many 
students. Perhaps it may safely be said that through identifi- 
cation with those who articulated the concepts, by means of 
group conferences, the student sometimes came to recognize 



6O TRAINING IN PSYCHIATRIC SOCIAL WORK 

for the first time the validity of the mental hygiene approach 
and was therefore free to respond to the training situation 
with a more objective attitude. 

The Initial Conference 

The initial conference, at which the findings in all four 
fields were discussed by the workers participating on the case 
as soon as possible after the preliminary examinations, pro- 
vided an opportunity to interpret the findings in each field in 
relation to the material obtained in the others. On the basis 
of the integration of these findings through the group think- 
ing, some tentative formulations were arrived at concerning 
the underlying causes of the difficulties in adjustment re- 
vealed, and some means of working out a helpful treatment 
approach to meet the needs indicated. 

The usual routine of case presentation at the initial staff 
conference was as follows: the examiners in all four fields 
read in turn a summary of their findings or gave them infor- 
mally from notes unless in the particular instance the exami- 
nations were sufficiently brief to be read in full. The psychi- 
atric examination was frequently given in full because of the 
difficulty of summarizing this material without sacrificing 
that which was essential to as complete an understanding as 
possible of the patient's behavior and personality. 

To many students, especially at the beginning of their 
training, the difficulties involved in summarizing the social 
examination appeared no less insurmountable. Where so 
much emphasis was put on the need for exploring the child's 
environmental setting and obtaining material on the causa- 
tion of his emotional attitudes and on those of other mem- 
bers of the family group, they felt there was no justification 
for omitting any of these important findings. While the staff 
recognized that this point of view was sound and that certain 



GROUP CONFERENCES 6l 

very real values were sacrificed in summarizing such vital 
material, it was not possible from a practical point of view to 
give the time for the full presentation of each social exami- 
nation. The experiments that were made with verbatim re- 
porting within the special staff unit, with its small staff, rela- 
tively small case load, and consequent opportunity for more 
frequent conferences, were a constant reminder of the out- 
standing advantages of this procedure often utilized in 
smaller psychiatric clinics. If the Institute had continued, it 
is probable that some way would have been found to hold 
more frequent and informal conferences and to utilize more 
generally full reporting of the findings in the field of social 
service and psychiatry. 

On the other hand, the process of summarizing had its 
own training value since it helped to clarify for the students 
what material was significant in throwing light on the causa- 
tive factors underlying individual behavior. The clearer 
thinking thus achieved developed the students' ability to 
make a more sensitively discriminative minimal examination. 
Perhaps no other process brought home to the students more 
effectively in the early part of their training that in their 
enthusiasm for exploring the total social picture they some- 
times acquired factual detail which was of little significance 
because they had failed to get below the surface into the 
emotional implications that such material represented for the 
individuals concerned. 

While there was an essential agreement among staff mem- 
bers as to the material which should be included in the social 
examination, there was some diversity of opinion as to how 
the students might be helped to develop discrimination in 
obtaining it. It was felt not only that the experience of sum- 
marizing the social examination but also the form of the 
summaries presented at the initial conference could be made 



62 TRAINING IN PSYCHIATRIC SOCIAL WORK 

a useful tool in training toward the development of such dis- 
crimination in history taking. Therefore in making and pre- 
senting the summaries, various arrangements of the material 
were tried although the content was, in general, always the 
same. A condensed family history was given, followed by a 
synopsis of the birth, developmental, health, school, play, 
work, and general behavior history of the patient. The order 
however varied, either the family history or the patient's his- 
tory being given first. To some of the clinic staff the latter 
method was found preferable because it tended to place em- 
phasis on the child himself. Ordinarily he was the only mem- 
ber of the family group seen by the psychiatrist, psycholo- 
gist, and pediatrician before the initial conference and the 
one with whom they were primarily concerned. They found 
it more stimulating to their interest in the total social picture 
to focus on the child at the start and to make a later transi- 
tion to family history, rather than to arrive at their impres- 
sions of the child less directly through the medium of the 
interacting family relationships. Another reason frequently 
given for preferring this order was that it stimulated the stu- 
dent to obtain more complete information about the child, 
particularly with regard to the birth and early developmental 
and health history, so essential to an understanding of the 
genesis of the present emotional responses to his environ- 
ment. Moreover, throwing the spotlight on the child was 
thought to heighten interest in the present relations of the 
parents to each other and to the child and tended to obviate 
the difficulty sometimes encountered of too indiscriminate 
preoccupation with early parental history. 

Certain members of the clinic staff, on the other hand, felt 
it was important to give the family history first because in 
this way the causative factors underlying the mechanisms of 



GROUP CONFERENCES 63 

the child's personality were emphasized. Still others thought 
both these methods of presentation involved too much repeti- 
tion and were too static and that some way of presenting 
findings should be used which would be simple to follow and 
which would retain more of the spontaneity and flow of the 
material as it came through from the clients to the workers. 
Experiments in this direction were made but a longer time 
was needed to achieve substantial progress in developing a 
more vital method. It is of course true that form has no 
reality apart from content, and that as content is rich or mea- 
ger, form is correspondingly dynamic or static. But often 
through experiments in form one is able to stimulate the stu- 
dent's awareness of her need to be imaginative and resource- 
ful in her approach to her clients. 

At some time during each student's training at the Insti- 
tute it was planned to give her an opportunity herself to 
integrate, interpret, and present for discussion at the initial 
group conference the findings on a new case in all four fields 
of study. This plan was not consistently carried out, partly 
because of lack of conviction of its value on the part of some 
of the staff, and partly because of the extra effort required in 
carrying through any project additional to the usual routine. 
This was a very real consideration when the majority of the 
students found it necessary to do a great deal of work over- 
time in order to keep up with their regular program. The 
procedure is only referred to here because in a number of in- 
stances it was found to be of value in aiding the student to 
gain the conviction more quickly than she otherwise might 
that the contributions of the pediatrician, the psychologist, 
and the psychiatrist were essential to a complete understand- 
ing of any case which was to be treated on an intensive basis. 

When such a procedure was followed the student's pres- 



64 TRAINING IN PSYCHIATRIC SOCIAL WORK 

entation of the case was most successful when based on an 
outline giving the problems revealed in the study and sum- 
marizing the information gained from all of the fields in- 
cluded in the fourfold approach which threw light on the 
causations of the problems. Aside from its training value, this 
method had an advantage in itself since it eliminated the 
necessarily artificial and arbitrary method of separating the 
findings, which occurred when the examiners in each field 
presented the material. 

In spite of all efforts to direct discussion in conferences to 
the case as a whole, often it was found that with the usual 
procedure of having each examiner contribute his report 
there was a concentration on points of particular interest to 
some of the group present. This sometimes left the student 
with an impression of spotty and uncoordinated thinking, and 
perhaps considerable confusion as to the need for social serv- 
ice participation in cases where the medical, psychological, or 
psychiatric issues had been stressed. Since, however, presenta- 
tion of material by the examiner in each field requires the 
least preparation, it is the type of procedure ordinarily 
adopted by clinic groups. It is probable that in the long run 
the student gained more from participating in conferences 
conducted in this way, with whatever strength or weakness 
they might have, because they represented one of the reality 
factors to which adjustment would have to be made when 
she was actually holding a job at a clinic. Also this procedure 
has the value common to all conferences of throwing the re- 
sponsibility back on the student to coordinate and integrate 
the material which has developed in the group discussion in 
order that she may gain a clear understanding of all the im- 
plications in a case. Therefore the real values of group think- 
ing which are a stimulus to and not a substitute for individual 
thinking were sustained. 



GROUP CONFERENCES 6$ 

The Treatment Conference 

Following the initial conference, treatment conferences 
were held at intervals usually not exceeding three months as 
long as the case was active, to review trends in case movement 
and to draw on the combined experience and creative imagi- 
nation of the group for an evaluation of the situation with a 
view to future handling. In the latter years of the Institute, 
there was a growing trend toward greater flexibility in the 
handling of group conferences on cases, less distinction being 
made between initial and treatment aspects in order to em- 
phasize the continuity of treatment from the first contact on 
a case throughout the period in which it was carried at the 
clinic. There was also a tendency for all group conferences to 
be held informally and spontaneously at more or less fre- 
quent intervals in the movement of the case. The scheduling 
of the conferences was determined by the need for the ex- 
pression and clarification of the thinking of the participants 
in therapy, dependent only on the individual situation and 
not according to routine. 

One of the more important training considerations in 
treatment conferences was the necessity constantly to focus 
attention on the whole movement in the case. In a training 
center such as the Institute, there was seldom opportunity to 
give the continuous handling of a case to one person. When 
student workers left, their cases had to be reassigned to other 
students who found it necessary, in order to orient them- 
selves, to review the past history of the clients. When she 
took over the old case, the student had to understand not 
only the meaning of the client's life experiences before he 
came to the clinic for help, as far as these were known, but 
also what his experiences since then had been, and how he 
had reacted to them both in his own environment and in his 
relationships with the clinic workers. Such an understanding 



66 TRAINING IN PSYCHIATRIC SOCIAL WORK 

was considered essential because the client's relationship with 
the present worker was to some extent conditioned by his re- 
lationship with the previous Institute workers, with whom he 
would more or less identify her. Unless the meaning to the 
client of this series of relationships was understood by the 
worker, his response in the present relationship could not be 
adequately interpreted. Also one important way of gauging 
the client's ability to profit by these relationships was through 
his response to other people and his handling of the practical 
matters of everyday living. The difficulty of exploring the 
total situation in a case is evident, especially when the case 
records represented the work of several years. In view of the 
recent trend in case work toward emphasizing the relation- 
ship of the present worker and client as all important, the ef- 
fort of reviewing such bulky records may be considered 
by some to have questionable value. How complete the re- 
creation of the past situation should be must be judged in the 
light of an agency's interpretation of its case work responsi- 
bility and its case work philosophy. 

The aim of treatment at the Institute in general was to 
help the client to work out in his relationship with the thera- 
pist a growth in personality in the direction of certain norms 
of social adjustment. It was recognized that norms of per- 
sonality growth are necessarily tentative, since they are based 
on individual abilities and limitations rather than on any arbi- 
trary standard imposed from without. However, it was gen- 
erally felt that such standards were helpful in testing the 
progress of the client in ability to relate himself successfully 
to reality situations. This approach may be thought an at- 
tempt to arrive too quickly, or too superficially, at a working 
adjustment for the individual. Perhaps it does not as often 
involve the deeper emotional levels implied in the kind of 
relationship therapy now utilized in many case work organi- 



GROUP CONFERENCES 67 

zations and described, for example, by Miss Virginia Robin- 
son. 1 

Since, in general, in Institute case work practice an effort 
was made by the worker not only to help the client to grow 
and to change but to be aware of how his emotional experi- 
ences involved in such a process were affecting his relation- 
ship with others, as an index of adjustment, the worker espe- 
cially needed to keep in sight the causative factors underlying 
present mechanisms. This understanding was essential to 
guide the worker in the relatively active participation in the 
solution of the client's problems. Therefore, a new student 
in her first treatment conference on an old case that had been 
reassigned to her was helped to an understanding of what her 
approach to the client should be, not only by the group dis- 
cussion of the present situation, but also by her preparation 
in familiarizing herself with the total movement in the case 
up to the present. 

In later treatment conferences held on the same case it was 
equally important that the student should not lose sight of 
any significant movement in the case since the preceding con- 
ference, or of the background for such movement repre- 
sented by the total case situation. On this basis the student's 
plan for further handling of the case could be most effec- 
tively integrated with that of the other workers participating 
in therapy. 

Other Group Conferences 

The case work conference, held because some emergency 
had arisen or because of indications recognized by any of the 
professional staff participating in the treatment of the case 
that an immediate shift in emphasis in handling the situation 

I Virginia P. Robinson, A Changing Psychology in Social Case Work (Chapel 
Hill: The University of North Carolina Press, 1930). 



68 TRAINING IN PSYCHIATRIC SOCIAL WORK 

was needed, usually represented a sufficient challenge to the 
imagination and resourcefulness of the group to bring out a 
dynamic interchange of ideas, and to furnish a stimulus to 
the student's approach to handling the case. 

One-day diagnostic consultation conferences (Chapter II, 
page 32) were held once a week during the years 1930- 
1932 and sometimes as often as twice a week in 1932-1933. 
The examinations in the physical, psychiatric, and psycho- 
logical fields on the cases discussed at these conferences were 
made in the morning preceding the conference, and were of a 
briefer kind than those usually given. The social findings 
were furnished by the agency, occasionally supplemented by 
such material as the student could gather in one brief inter- 
view with a parent, or parent substitute, interviewed at the 
Institute while the child was being examined. The manner in 
which these cases were handled, therefore, was similar to one 
type of brief service often utilized in clinics which have more 
constant pressure resulting from heavier community de- 
mands, and where limitation of time necessitates less inten- 
sive service than was usually given at the Institute. The 
consultation study of these cases was leveled at diagnosis and 
tentative recommendations only, with a view to supplying 
other individuals or agencies with assistance in their current 
treatment responsibility. In the belief that such a service re- 
quires more rather than less professional experience, the di- 
rector or chief of staff participated in the examinations with 
the psychiatric fellows and acted as chairman of the discus- 
sion in conference. The presentation and discussion were in- 
formal and aimed to telescope the thinking on the case in the 
light of the outstanding case needs and available facilities for 
handling them. The referring agency participated in the dis- 
cussion. Frequently as many as three cases were examined 
and discussed at a conference in one day, thus affording the 



GROUP CONFERENCES 69 

students an opportunity to get a picture of the possibilities o 
quick brief service, and its adaptation to the needs of other 
agencies. 2 

Attendance at Conferences 

Since such a large proportion of the student's time was oc- 
cupied in activities related to her own case work, it may be 
readily seen that the time allowed for visiting conferences on 
other students' cases would have to be controlled and mini- 
mized to a great degree. Many students, especially those 
most experienced in case work before entering the Institute, 
were eager to attend conferences as auditors, thinking that 
much could be gained from contact, even though superficial, 
with a wide range of problems and from the thinking of 
members of the clinical staff with whom they would not 
otherwise be in touch. Granting the validity of this in theory, 
for want of time it was possible in practice only to a limited 
extent, as may be seen from the figures on Conferences 
visited (Tables I and 2, pages 37 and 38). The one type of 
conference which the students were urged to take time to visit 
as frequently as possible was the one-day diagnostic consulta- 
tion conference, referred to above. Student attendance at 
these conferences was particularly emphasized because of the 
training values implicit in familiarity with the possibilities of 
this type of brief service and with the personnel and policies 
of other agencies. 

2 The training value of consultation cases referred by parents has been discussed in 
chapter ii, page 20. 



V 
SUPERVISOR AND STUDENT 



SOME of the experiments made at the Institute with the 
purpose of achieving an increasingly helpful relationship 
between supervisor and student have been referred to in the 
preceding chapters. Success in this relationship was primarily 
due to the imagination and maturing philosophy of indi- 
vidual supervisors, and it is unfortunate that more of their 
actual experience with students is not recorded. However, 
there was an extensive interchange of ideas on supervision 
both informally among individuals and in the conferences of 
the social service staff, held once a week in the early days of 
the Institute and at less frequent intervals in the latter years 
when there was less need for orientation of the group to gen- 
eral policies and methodology of training. The conference 
held once a week throughout the six years of the Institute's 
existence, and attended by members of all the permanent 
professional staff, provided another channel for discussion of 
supervisory problems and techniques. Consultations between 
the case work supervisor and the educational supervisor, and 
between each individually or together with the chief of so- 
cial service, were also productive of the exchange of ideas on 
supervision. Further contribution to common understanding 
was made in conferences with students on training methods 
held at certain times by the case work supervisors and by the 
educational supervisors and chief of social service. Valuable 
suggestions on student reactions to training frequently came 
from members of the professional staff in the other clinical 



SUPERVISOR AND STUDENT 7! 

divisions exclusive of social service, as a result of their indi- 
vidual contacts with students. 

While an attempt is made in this chapter to re-create some 
of the thinking underlying the approach to problems of su- 
pervision, it is impossible to make more than a generalized 
survey here of the supervisor-student relationship. It is 
hoped that more complete analyses of this subject will be 
made in the future by individuals currently active in supervi- 
sion who have had supervisory experience for several con- 
secutive years. Only through such contributions can real 
progress be made in developing more helpful relations be- 
tween supervisor and student, based on expanding knowledge 
and experience. 

Assignment of Students to Supervisors 

At first as many as eight students were sometimes assigned 
to one supervisor, but at the end of two years' experience it 
was found to be impractical for one worker to supervise so 
many, and the number was reduced to six except in rare in- 
stances. In inquiring, in 1930, into the policies of other train- 
ing centers, it was discovered that in some of those whose 
standards both for case work and student training were high, 
the maximum number of students per supervisor was six. 
This ratio was particularly significant in the case of one 
agency which did not function on a clinical program, and 
where a selected group of supervisors was free to spend prac- 
tically full time in direct work with students. In comparison 
with the demands on the time of supervisors necessitated by 
the fourfold study and treatment plan at the Institute, it is 
evident that the supervisors in this particular non-clinical 
agency had an advantage, which those at the Institute lacked. 
The experience of other agencies also confirmed the experi- 
ence at the Institute that while theoretically it may be an ex- 



72 TRAINING IN PSYCHIATRIC SOCIAL WORK 

cellent thing for a supervisor to carry case work concurrently 
with her supervision, from the practical standpoint it is diffi- 
cult, if not impossible, to plan for this as a definite part of 
the supervisor's responsibility, especially if she has six or 
more students. Moreover, at the Institute, the supervisor had 
to assume direct responsibility for cases on those days of the 
week when her students were not available for field work 
and during the summer quarter, when fewer and less sea- 
soned students were accepted for training. 

At the same time that a reduction was made in the number 
of students carried by any given supervisor at the Institute, a 
change was made in the general distribution of students. 
During the first two years, the students from both schools 
had been divided among six case work supervisors, but now 
three supervisors took over the work of training students 
from the New York School and three that of training stu- 
dents from the Smith College School. Through this arrange- 
ment it was hoped that the supervisor might more easily fol- 
low the training plan of the one school represented by her 
students, and thus facilitate the integration of the students' 
theory and practice. As far as this was practical, the super- 
visors were given students from the school in which they 
themselves had taken training. It is possible that in the pro- 
gressive working out of this plan, carried on for the succeed- 
ing two years, the students were also helped by the fact that 
the old cases taken over by them had been previously worked 
on by students from their own school, who presumably uti- 
lized certain techniques and emphases in case work approach 
characteristic of that school. 

At this point there will doubtless be many who would 
question the wisdom of what may appear to be a policy of 
overemphasis on specialization rather than on variety in ex- 
perience. In fact, however, there was great variety in the 



SUPERVISOR AND STUDENT 73 

presentation of psychiatric theory, due to the different ap- 
proach represented by instructors at the respective schools, 
by the clinical psychiatrists, and by the psychiatric fellows in 
training at the Institute, as well as by the director and chief 
of staff who were often participants in the group confer- 
ences. Reduction of the approach to case work by the social 
service staff to the simplest possible terms, therefore, might 
well be looked upon as a valuable asset in stabilizing and co- 
ordinating the students' points of view. If this policy seemed 
sound at this particular point in our knowledge and under- 
standing of the problems involved, it must be recognized that 
it, like all the other important policies in training, was tenta- 
tive and subject to change, should this seem advisable. 

Relationship to Students 

While it was recognized that the students brought to the 
training situation certain attitudes and needs which they 
would tend at first to project into their relationship with the 
supervisor, this was not necessarily discussed with them ei- 
ther at the beginning or at any other point in their training. 
Some attempt was made at the start to clarify for them the 
concept of the supervisor's role by bringing out in general 
discussion that she was primarily interested in helping the 
students to broaden their knowledge and understanding of the 
meaning of human behavior and to refine their techniques of 
treatment, and that she did not wish either to hamper their 
initiative or to place too much responsibility on them before 
they were ready to assume it. Frequently, especially at the be- 
ginning of the training period, it was not possible for the stu- 
dent to accept the relationship on these terms, which implied a 
maturity of point of view and a degree of security within her- 
self which she had not yet attained. Often her dependency 



74 TRAINING IN PSYCHIATRIC SOCIAL WORK 

needs became evident in her tendency to put the supervisor in 
the position of substitute parent and to project responsibility 
on her, showing little interest in helping herself. Other stu- 
dents, equally insecure, tended to reject the supervisor from 
fear of giving in to the need of leaning too heavily upon her. 
Their essential insecurity may have been manifested in a va- 
riety of symptoms} such as rejection of supervision and of 
the concepts of mental hygiene, as well as resistance to the 
flexible and tentative approach utilized in case work in a psy- 
chiatric clinic. It would be possible to multiply almost indefi- 
nitely examples of such symptoms, which any experienced 
supervisor would recognize and identify as similar to those 
encountered in her own students. Although the arrangements 
for supervisory conferences were kept very flexible, when the 
avoidance of them became marked the student sometimes 
telephoning from the vicinity of the homes of her clients to 
report that she was being unavoidably detained, or else 
allowing numbers of appointments to pass without explana- 
tion some difficulty in adjustment to the supervisory ex- 
perience might usually be correctly inferred. Such a student 
when she did appear for her supervisory conference, would 
sometimes attempt to dominate it by talking of irrelevant de- 
tails or by interrupting the supervisor whenever she tried to 
bring the discussion around to important issues. Another stu- 
dent might sit on the edge of the chair prepared for flight, 
on one pretext or another, such as that a client was waiting 
for her. Instances there were, also, of students withholding 
material from records and explaining later that, since they 
had felt the supervisor neither understood nor sympathized 
with their point of view, they thought they would get better 
results in treatment unhampered by the supervisor's sugges- 
tions. Students showing this kind of difficulty in relating 
themselves to supervision, were often very critical of the 



SUPERVISOR AND STUDENT 75 

agency's records and of the work previously done on their 
cases by one or more of the clinical team. 

In some instances students who were carrying into the 
present situation earlier emotional needs for authority and 
punishment gave evidence of persistent feelings of failure 
and inadequacy, or of a wish to put themselves in the wrong 
by evading responsibilities and making trouble for the super- 
visor by disregarding routine, misinterpreting her statements, 
and so on. Since the latter type of response was often similar 
to that of students who had an emotional need to reject au- 
thority, it was of course essential that the supervisor should 
discriminate in terms of the total personality reactions of the 
student as she saw them and direct her handling of the situa- 
tion accordingly. Examples of this type of response identi- 
fiable as arising from a need for punishment are: the failure 
of a student to carry through routine details, such as verifica- 
tion of birth dates prior to the psychological examination, the 
scheduling of appointments for conferences or for patients to 
be seen at the clinic, the writing of important letters and re- 
ports, etc. In this same category we may list failures to make 
contacts on cases, and a piling up of "write-ups" on cases 
which the student delays to write or dictate so long that the 
rest of the clinical staff interested in the case are seriously 
handicapped in treatment. More direct bids for punishment 
are shown by the student who comes to the supervisory con- 
ference having given no thought to material for discussion 
and who tells the supervisor that she deserves a scolding for 
this; by the student who "has a confession to make," that 
after having planned to take up certain points with one of her 
clients on her next visit, if the opportunity arose, she allowed 
several good openings to slip by without utilizing them; and 
by the student who constantly seeks criticism of her work, 
even though the supervisor has already attempted to help the 



j6 TRAINING IN PSYCHIATRIC SOCIAL WORK 

student make an evaluation of her work for herself, and so 
on. 

The experienced supervisor, whose own security was not 
threatened by the evidences of such attitudes, was able to 
recognize the importance of these symptomatic responses and 
to help the student work through to a more self-assured and 
progressive attitude. 1 

In surveying the experience at the Institute in the light of 
the comments of students at the completion of their training, 
the most frequently recurring criticism was that the staff, in 
their anxiety not to overprotect the student and to let her do 
her own thinking and acting freely without the imposition of 
anything which might look like the exercise of authority, had 
emancipated her too early. In some instances it was felt that 
the student had insufficient background of experience to 
guide her in dealing with her case work processes or to evalu- 
ate her successes and failures. In others we may recognize 
that in such comments the student's own problems were re- 
vealed. For example, one individual had a great need for de- 
pendency, so that she could only interpret her supervisor's 
efforts to make her independent as a rejection of her person- 
ally; another student had not only wished to be dependent 
on her supervisor, but was unconsciously demanding punish- 
ment from her in the form of criticism in order to ease her as 
yet unsolved problem of guilt. With due allowance for all 
the subjective elements underlying it, the criticism cannot be 
dismissed. It was not representative of the opinion of the 
whole student body; there were students who considered that 
they had not been allowed enough freedom, and others who 
stated that the supervisory relationship had as closely ap- 
proximated an ideal balance of guidance and freedom as 
probably could be achieved. If we were to accept this latter 

x For specific methods used in helping such students, see pages 89 and 90. 



SUPERVISOR AND STUDENT 77 

testimony as true, because it seems to represent the most ob- 
jective attitude of students who had no difficulties in han- 
dling authority-dependency relationships and were therefore 
free to accept the mature sort of supervision in which all the 
help they needed was available for the asking, and nothing 
was superimposed on them, such complacency would cer- 
tainly be open to well justified suspicion by others. 

Since in the relatively small and carefully selected group 
of supervisors it is perhaps safe to assume that there are 
fewer outstanding personality difficulties than in the larger 
and relatively less carefully selected student body, we may 
be justified in minimizing to some extent the misuse of the 
authority-dependency relationship by the supervisor. That 
such problems do arise, however, with supervisors as well as 
with students, is a point unfortunately too well established to 
need elaboration here. At times, then, during the training 
process it is undoubtedly true that the supervisors failed to 
measure up to an approximation of the ideal of objectivity in 
handling their individual supervisory relationships. 

The supervisor must increasingly be ready to bear the 
brunt of the responsibility for refining her techniques of su- 
pervision to the point where she will do a more adequate job. 
And in attempting to become more effective she must always 
turn again to the analysis of the students' needs to guide her. 
It does not matter if the protests against too early emancipa- 
tion or too inflexible control come from students insecure in 
their own personality integration. Such students presumably 
will always fall to the supervisor's lot. Recognizing this, she 
must readjust her methods, so that she allows one student a 
certain necessary period of dependency upon her, emancipat- 
ing her more gradually than she would another more secure 
student; and helps another student to vent her hostility upon 
her, while gradually leading her to see that the authority 



78 TRAINING IN PSYCHIATRIC SOCIAL WORK 

with which she has invested the supervisor is fictitious and 
not a reality to be combated. If such a plan is followed, the 
supervisor will soon have few if any "problem" students on 
her hands, and will not have compromised her conviction that 
a supervisor should not encourage a student to talk of her dif- 
ficulties or attempt to enter into a psychotherapeutic relation 
with her. 

Some students there will always be whose difficulties are 
too deep-rooted and too complex to respond to such superfi- 
cial handling, and who will find the flexible control of the 
supervisor not sufficiently stabilizing to carry them over the 
training period. At the Institute, perhaps due to the limita- 
tions of the staff, too many of the students seemed to fall 
into this category. However, when superficial handling of a 
student's difficulties proved inadequate, the Institute policy 
was to encourage her to consult a psychiatrist, preferably not 
one on the Institute staff because of the complications inher- 
ent in close working relations with a staff member as psycho- 
therapist. This difficulty would, it was considered, be even 
more pronounced if the student's supervisor assumed the 
role of therapist, even though her objective qualifications for 
handling the situation on this level might be, and often were, 
adequate. Often it must have seemed arbitrary, or worse, to 
the student finding herself in an emotional jam and eager to 
talk out some of her most pressing difficulties with the super- 
visor, to be brought back again and again to a discussion of 
the needs of her cases, and eventually to recognize that she 
was being encouraged to look elsewhere for personal help. 
The student in such cases may easily have felt the more frus- 
trated because of her confidence in the stability and sym- 
pathetic understanding of the supervisor to whom she had 
easy access, and who provided the logical opening to speak of 
her needs. Frequently, however, she was quick to see that the 



SUPERVISOR AND STUDENT 79 

time available was too limited to make it possible for the su- 
pervisor to be of real help in working out her difficulties; and 
that, in general, it requires an unnecessary expenditure of 
energy to make an adjustment to an individual on two levels, 
such as the rather impersonal one of supervisor and the more 
personal one of therapist. The student was not prepared to 
see, nor was it necessary for her to see at this point, that the 
supervisor, in assuming the position of therapist, might be- 
come invested to an extreme degree with attributes with 
which the student was already endowing her in a milder and 
more easily handled form. To be more specific, the combined 
supervisor-therapist might symbolize the much loved and 
depended-on parent or sibling, or the unsympathetic and re- 
jecting one, or both in turn, and henceforth all working rela- 
tionships with her would be immensely complicated until 
this pattern was slowly outgrown. All the resulting compli- 
cations of possible jealousy toward other students, who for 
the time being would have become rivals for the supervisor's 
interest and attention, would provide further obstacles to the 
success of such a relationship. 

Unquestionably, many times it was possible for the super- 
visor to give a student who was emotionally upset a great 
deal of help indirectly, through the discussion of a diversity 
of issues arising in her cases. In this way, she led the student 
to work out an interpretation of causative factors and 
methods of treatment approach, giving particular considera- 
tion and careful handling to those situations in which the stu- 
dent was identifying herself with a client. This gradually 
helped the student to build a substantial foundation of actual 
experience, which enriched her understanding of the pur- 
posiveness of human behavior and the dynamic potentiality 
inherent in each individual for creating within himself new 
and more harmonious patterns of response to the world he 



8O TRAINING IN PSYCHIATRIC SOCIAL WORK 

lives in. At this point, psychiatric concepts ceased to be theo- 
retical for the student and became a very real part of her 
thinking and feeling, affecting her attitudes toward herself 
as well as toward others. This result in general is the major 
objective of all training in case work. Some students may 
arrive at it more easily than others, and to some it will have 
more far-reaching implications in terms of their own person- 
ality adjustment than will be true of others, but the goals 
are the same for all. The criterion of success in the training 
situation is the students growth in overcoming or accepting 
her limitations, rather than the extent to which she has meas- 
ured up to some theoretical standard set by students of very 
superior personality equipment and of particularly mature 
emotional adjustment. The experienced and skilled super- 
visor was necessarily aware of the complex implications of 
the personality differences in her students. She recognized 
that even when apparently similar needs for dependency or 
authority were evidenced by several of her group, it was sel- 
dom possible to use the same methods for helping any two 
of them to achieve the security essential to professional 
growth. 

In the preceding discussion, general aspects of the student- 
supervisor relationship have been described but not the ex- 
perience of any particular student. The need for study of 
specific examples of the relationship by individuals actively 
engaged in supervision has already been mentioned. Mean- 
time, the development of this relationship has been given 
such a complete exposition in Miss Robinson's book, A 
Changing Psychology in Social Case Work, in the chapter on 
The Worker and Her Preparation, which seems to synthesize 
and to enrich the most advanced thinking of psychiatric social 
workers to date, that there is so far little more to contribute 
to the understanding of what factors should enter into the 



SUPERVISOR AND STUDENT 8 I 

situation in which the student is free "to think, to experi- 
ment, to grow, to change." 2 

However, in each clinic there will perhaps always be a dif- 
ferent emphasis on case work responsibility, objectives in 
treatment, and methods of attaining objectives. In so far as 
such differences exist, the training emphasis will vary. For 
example, the philosophy of an agency which attempts to set 
the client free to grow toward a solution of his problems by 
means of the dynamic relationship with the worker without 
external manipulation or control, will develop a philosophy 
of training which tends to emphasize a similar relationship 
between student and supervisor. In such a situation the de- 
velopment in the student of an ability to "resign her reliance 
upon social norms, moral standards, and sound treatment 
plans, in favor of limited treatment ends and the stimulation 
of growth processes within the individual which may carry 
him she knows not where" 3 may be considered the criterion 
of success. 

At the Institute, the philosophy of case work was on the 
whole concerned with helping the client, through the 
worker-client relationship, to achieve growth in personality 
adjustment in which the recognized goal was an increasing 
ability to meet the demands of everyday living with relative 
objectivity. The client's integrity as an individual and his 
right to freedom of choice were constantly held to be of the 
highest importance, and the attempt was made to exercise 
direction or control only in so far as this was possible within 
the limitations set by these concepts. In the same way, in the 
relation between student and supervisor, the objective to be 
achieved was a balance between freedom and direction. 

2 Virginia P. Robinson, A Changing Psychology in Social Case Work (Chapel 
Hill: The University of North Carolina Press, 1930). 

3 Op. cit. 



82 TRAINING IN PSYCHIATRIC SOCIAL WORK 

The fact that the case needs of the agency furnished a con- 
trolling force that could not be disregarded probably created 
difficulties in supervision less generally than might have been 
anticipated, owing primarily to the freedom of the relation- 
ship between supervisor and student. It would obviously be 
unsound to suggest that such an ideal relationship of free- 
dom and security on the part of the student and objectivity 
on the part of the supervisor was the rule. It was rather the 
objective held by each supervisor, and attained by her with 
varying degrees of success at different times and more with 
some students than with others. 

Training Methods 

The process by which the supervisor individualized the 
training experience for the student was not based primarily 
on selection of cases, although this method was sometimes 
used. She depended rather on the adaptation of the content 
of her conferences with students to their emerging needs, 
giving reinforcement where they needed it and withdrawing 
support where they could function on their own responsi- 
bility. In addition, she was ready to help the student coordi- 
nate all her activities in such a way as to get the maximum 
benefit from her experience with the minimum of waste ef- 
fort, in so far as this could be effected without hampering the 
student's own initiative. In other words, a consistent effort 
was made in Institute training to relieve the individual as far 
as possible from the need to function slowly and expensively 
by the trial-and-error method, at the same time releasing her 
to assume the maximum responsibility for which she was 
ready. 

The point at issue here would seem to be one of economy, 
obviously one of the fundamental principles underlying all 
processes of student training. It is indeed a wise supervisor 



SUPERVISOR AND STUDENT 83 

who knows just when to give and when to withhold. Some- 
times she may speed up a student's progress by manipulating 
the situation in any of several ways: by selection in the as- 
signment of cases whenever possible j by laying emphasis on 
the need for certain types of group conferences; or by shar- 
ing her own philosophy and fund of skilled techniques, so 
that processes stand out simplified and in such clear relief 
that assimilation for the student is a relatively easy matter. 
At other times she must withdraw herself from the situation 
in order to allow the student to assert her own independence, 
very much as if she were carrying a lone job in which she had 
no one to turn to for assistance. Clearly the supervisor's com- 
pass, in steering this difficult course, must be the student's 
need and level of understanding at each step in the training 
process. Though this may be axiomatic in theory, in practice 
it is not simple. 

Many students felt themselves overwhelmed at the start 
of their training at the Institute by the unf amiliarities of the 
set-up, and the emphasis on intensive treatment rather than 
on short service and volume of work. In an attempt to meet 
them at the initial level of their understanding, the super- 
visor sometimes utilized her knowledge of their past experi- 
ence to point out its similarity to the present situations with 
which they were dealing. In this way it was possible for the 
students to see that it was not necessary to scrap all the 
knowledge which they had acquired through previous case 
work experience or in their relations with family, friends, 
work associates, and so on, but that they could become more 
discriminating in their approach through understanding the 
reasons for their success and failure. To some extent it was 
also possible for the supervisor to give the student unfamiliar 
with the social psychiatric approach to cases, some interpreta- 
tion of how she herself would apply her understanding of 



84 TRAINING IN PSYCHIATRIC SOCIAL WORK 

human behavior and relationship techniques to certain spe- 
cific situations which the student felt unable to handle. It was 
important, however, that such interpretations should be kept 
so simple that the student could easily grasp and utilize 
them. The method was relatively seldom used, because of 
the emphasis on the need to encourage the student to do her 
own thinking, but if careful consideration was given to the 
student's individual needs, as she brought them up spontane- 
ously in discussion, the procedure often was a means of has- 
tening the integration of the student's theory with practice. 

While such methods obviously played into the dependency 
patterns of the students, the conviction of their value was re- 
inforced as it became apparent that some students had been 
expected to assume a greater degree of responsibility than 
they were equipped for, especially in the first quarter of their 
training. 

Some supervisors were reluctant to offer any criticism of 
the students' work even in the early period of their training, 
for fear of encouraging them to project their responsibility 
and to rely on the supervisor to make decisions for them. To 
provide a substantial basis for autocriticism, for students 
who did not have a sufficient background of experience for 
the practical utilization of social psychiatric concepts and who 
were showing concern about their ability to evaluate their 
work, it was often helpful to suggest that they select a case 
for more detailed discussion of treatment during the super- 
visory conference than was usual. Even though this necessi- 
tated one or two additional conferences a week the results 
justified the extra expenditure of time. Discussing a case in 
this way furnished a stimulus to the student to utilize freely 
all her knowledge and understanding of the causative factors 
underlying the total case problems and the manner in which 
her treatment was affecting them, with the assurance that she 



SUPERVISOR AND STUDENT 85 

could bring up for more leisurely discussion any questions 
she had as to her interpretation or procedure. This in itself 
sometimes brought release from the pressure of attempting 
to assume more responsibility than she felt equipped for, and 
enabled her to clarify the whole process for herself with the 
minimum of assistance from the supervisor. In those in- 
stances where considerable supplementation and reinforce- 
ment in interpretation were needed from the supervisor, it 
was still possible to handle this constructively for the student 
by limiting such discussion to her needs as evidenced by her 
questions, and by presenting it on the level of her ability for 
assimilation. Any possible threat to her security which might 
be caused by revealing to the student areas of lack of under- 
standing and resulting errors in treatment approach, was 
minimized by scheduling such discussions as soon as the stu- 
dent herself became aware of the need for clarifying her 
thinking and approach to her cases on a somewhat more in- 
tensive level. Early in training it was possible to point out 
that gaps in understanding and errors in practice were preva- 
lent among all students new to the field, and ordinarily to 
forestall the utilization of such inadequacy on a subjective 
level as indicative of personal deficiency. Moreover, it was 
possible for the supervisor to limit this more intensive analy- 
sis of treatment procedures to one case at any given time, if 
an evaluation of progress on all her cases might give a particu- 
lar student too little sense of achievement before effective 
integration of theory with practice was evident. For many 
students, also, it was dangerous to encourage too much inten- 
sive analysis at any one time, since this might be utilized by 
them, consciously or unconsciously, to keep the training ex- 
perience on an intellectualized level. To such students any 
opportunities for spending time on the more or less academic 
exercise of case analysis would be seized upon as rationaliza- 



86 TRAINING IN PSYCHIATRIC SOCIAL WORK 

tions for remaining "rooted to their desks" and for failures 
to get into actual contact with their cases. 

This method of reinforcing the student's understanding 
and case wisdom through a relatively more intensive evalua- 
tion of the treatment on one or more of her cases than was 
usual in the regular supervisory conference, was not only 
valuable but also practically essential for all students at some 
point in their training, as a means of refining their tech- 
niques of handling case problems on a more intensive level. 
Frequently it was found of value to plan this kind of thor- 
ough analysis for most, if not all, of the student's cases 
toward the end of her first quarter of training in order to 
clarify progress up to this point. The student might be led to 
see that in her recognition of inadequacies in certain areas of 
treatment, gained through her increasing ability for keener 
discrimination of the values of her work, lay the evidences 
of growth which alone could be considered the criterion of 
achievement at this time. The increase in purposiveness and 
direction of the student's work in the succeeding quarters of 
training, as a result of this procedure, was frequently suffi- 
ciently marked to justify the very considerable time it took. 
With some students it was advisable to limit the number of 
cases analyzed and the time spent on any given case. In other 
words, this procedure necessarily had to be adapted to the 
needs of the particular student. It was generally recognized 
as unfortunate that the pressure of clinic work frequently 
made it impossible to plan for an intensive analysis of cases 
even when it was apparent that the student was ready to 
profit by this kind of experience. 

The feeling of achievement and satisfaction which it gave 
the student to obtain the material of her first social examina- 
tion and to present it for discussion at the group conference, 
has been mentioned previously. The supervisor, aware of the 



SUPERVISOR AND STUDENT 87 

value of this experience, was responsible for seeing that the 
student received an assignment of her own first new case as 
early in the training period as possible without destructive 
effect to the case or to her own sense of adequacy. The very 
real contribution to the understanding of the total case situa- 
tion ordinarily made by the material obtained in even a 
rather meager social examination was sufficiently apparent 
as a rule to stimulate the student's confidence in her profes- 
sional adequacy and in her ability to meet the clients' needs 
in treatment. With increased security, the student often felt 
less need to dominate the situations with her clients. This re- 
laxation of her attitude became productive of better rapport 
and consequently led to freer expression by the client of his 
needs as he saw them the essential groundwork of a sound 
therapeutic relationship. 

While work on her own first new case had value for every 
student, it was perhaps especially important for those who, 
early in their training period, were most fearful of becoming 
dependent on their supervisors and were consequently resis- 
tive in their attitude toward training. The gain in the sense 
of professional adequacy achieved through gathering the ma- 
terial of the social examination and contributing to the un- 
derstanding of the problems by the group at the initial group 
conference, was often an important factor in releasing them 
from the need to be hypercritical of the Institute personnel. 
The latter no longer seemed threatening to their security as 
student workers after the freedom of give-and-take discus- 
sion had given them a feeling of equality and collaboration 
with the group. In anticipation of the possibility of such a 
reaction, a supervisor might assign a new case to such stu- 
dents earlier than to others, and follow up the initial assign- 
ment with another new case more quickly than was ordinarily 
done. 



88 TRAINING IN PSYCHIATRIC SOCIAL WORK 

Of equal importance at this point in training was the em- 
phasis in group conferences on the need for a tentative inter- 
pretation of findings and on the experimental nature of the 
approach to treatment, which constantly needed to be re- 
formulated and readapted to meet the emerging and chang- 
ing needs of the case situation. Gradually the student was led 
to realize that because of the nature of the work there could 
be no general rules of procedure which she ought to knowj 
rather, she found, in working out each situation on an indi- 
vidual basis, that she increasingly had something of real 
value to contribute. Her earlier need for specific treatment 
formulations and her wish to achieve quick, concrete results 
ordinarily then became less dominant. 

The supervisor, interested in following all leads to facili- 
tate her student's adjustment to the training situation, 
adapted her own participation in the conferences, being ei- 
ther more active or more passive as the needs of the situation 
indicated. Often she found that it helped the student who 
resented "authority" to relate herself to the demands for 
readaptation in the unfamiliar setting, if she herself re- 
mained passive while the student assumed full social service 
responsibility for the case in discussion with the group. 

The early resistance shown by some students to the concept 
of the purposiveness of human behavior and the approach to 
treatment evolved on this basis, was often considerably mini- 
mized if the supervisors frankly admitted that this was the 
natural response of most thinking people to theory which had 
not been tested out in their experience. Discussion along these 
lines helped to relieve the students of the feeling that they 
were under pressure to come to decisions about such theories 
and gave them opportunity to try them out over a consider- 
able period in application to their cases. 

In general it may be said that the methods of the super- 



SUPERVISOR AND STUDENT 89 

visors in meeting the more common student difficulties in 
integrating theory and practice were indirect. Group confer- 
ences and the discussion of case material were used to help 
the student test out the theory she had become familiar with 
at the Institute, from her courses at the school, from her 
reading, and so on, and to relate it to concrete experience in 
such a way as to broaden and integrate her viewpoint. The 
security which the student needed in order to grow in the 
understanding of her clients and in the acceptance of her own 
limitations was developed in this way, the supervisor either 
permitting dependency for a time, or acceding to the stu- 
dent's need to be independent as this was indicated. 

More direct methods were sometimes necessary in the case 
of students who were still carrying over into the present 
situation earlier emotional needs for authority and punish- 
ment and who were unable to profit by indirect attempts to 
develop their powers of autocriticism and any substantial case 
work techniques. Sometimes the supervisor would initiate 
discussion of errors in the student's handling of the relation- 
ship with the client, putting less emphasis than usual on hav- 
ing her make the evaluations for herself. In thus laying bare 
the student's inadequacies, the supervisor necessarily assumed 
an authoritative role. This was done to relieve the sense of 
guilt experienced by students who felt they ought to assume 
independence and responsibility for their own actions but 
who were not emotionally ready to do so. It was obviously 
essential that the supervisor should be objective in discussing 
the situation in order that the student should not feel that she 
was being rejected because of her inadequacy. By showing a 
desire to understand the student's reasons for failure and to 
help her work out a better approach to the case problems, the 
supervisor was able to lead her to utilize her mistakes in gain- 
ing the increased insight essential to professional growth. 



90 TRAINING IN PSYCHIATRIC SOCIAL WORK 

Often it was also found helpful to go over their statistical 
records with such students, definitely pointing out inadequa- 
cies in numbers of cases carried, contacts made, and so on, be- 
fore attempting to help them budget their time with more 
economy. 

Inexperienced and experienced workers. The question is 
frequently raised, in training centers and in committees on 
student training, as to the differentiation in approach re- 
quired to meet the needs of inexperienced workers and those 
coming to the training situation with a background of experi- 
ence in other social work fields. In the discussion of the rela- 
tionship of student to supervisor, an attempt was made to 
cover the fundamental varieties of emotional imbalance in 
the timidity-authority range, which might be found at the 
root of student attitudes and responses and which were symp- 
tomatic of blocking in progress and growth. There was little 
emphasis in this discussion on discrimination between experi- 
ence or lack of experience as factors which contributed to the 
intensification of these problems for the students, and it may 
be said that this is an area in which it is impossible to make 
any generalizations. 4 Practically every degree of resistance 
to the concept of authority or dependence upon it may be 
found in students, both experienced and inexperienced. It 
is primarily in relation to this concept rather than in consid- 
eration of her technical equipment for case work that the 
supervisor must do her thinking and planning to meet the 
individual student's needs in the training situation. 

It is, however, important that the supervisor should al- 
ways keep in mind what the experience of the student has 
been, since the way in which the student has reacted to this 

4 See chapter vi for analysis of work of students of different age and experience 
groups. 



SUPERVISOR AND STUDENT 91 

may be very revealing of factors which contributed to the 
present situation. 

Ordinarily, perhaps, one would expect that the student 
who begins her training with little or no experience in case 
work would tend to be very dependent on the supervisor and 
to require a great deal of direct instruction not only in all the 
routine functions of the clinic but even in elementary case 
work procedures. In such instances it would seem necessary 
to recognize that the student might not even be in a position 
to know what to ask for, and that if she were left to her own 
initiative she might flounder helplessly, wasting much of her 
own valuable time and perhaps seriously impairing her sense 
of adequacy. In reality, however, there were individuals 
among such inexperienced students who had a very real emo- 
tional need to function independently and to gain a sense of 
achievement through putting their theoretical concepts into 
practice, and who rejected the efforts of the supervisor to 
help them adapt and humanize this knowledge in terms of 
the specific problems with which they were dealing. 

One exceptionally keen young student, for example, whose 
college experience was only a few months in the background 
when she entered the Institute, apparently had gained great 
satisfaction in academic achievement and at the start of the 
training situation professed great familiarity with psychiatric 
concepts. She was unable at this point to admit ignorance 
either of theoretical implications or even of concrete points 
about which she could have been expected to know little. She 
was very defensive about taking suggestions and following 
leads from the supervisor, tending to put a stop to discussion 
by insisting on her clear understanding of the situation, and 
maintaining that previous thought had brought her to the 
same conclusions as those the supervisor was leading up to. 



92 TRAINING IN PSYCHIATRIC SOCIAL WORK 

She evidenced considerable need to initiate all plans and ideas 
for treatment, although the essential insecurity and depend- 
ence underlying her rejection of opportunities for consulta- 
tion were naively manifested in her wish to get the super- 
visor's approval before putting such plans into practice. In 
this situation the supervisor was aware that progress in train- 
ing was dependent on her ability to give the student all the 
satisfactions to be obtained from working independently and 
from capitalizing her intellectual facility through the prepa- 
ration of material for conferences. 

Another way of meeting the problem was to encourage the 
student to consult other individuals on the staff, while the 
supervisor held herself in readiness to follow up any oppor- 
tunities the student offered for discussion of situations in her 
case work about which she revealed uncertainty and need for 
reinforcement. The student's early attempts to convince her 
clients on an intellectual level of the value of certain changes 
in attitude met with the usual lack of response or open re- 
sistance, which proved somewhat threatening to her. Her 
gradual acceptance of the value of consulting with the super- 
visor, however, did not develop at any point into an un- 
healthily dependent situation, since the supervisor had been 
careful to build up the student's sense of adequacy and 
achievement from the start. The problems in her case work 
were always discussed in terms of something which could be 
worked out cooperatively with the supervisor, whose under- 
standing, it was pointed out, was dependent on the student's 
contribution of first-hand information and on her identifica- 
tion in feeling with the client. This led to a gradual diminu- 
tion of the student's fear that she would be put in the posi- 
tion of being "taught" by the supervisor. As her defensive- 
ness toward the "authority" with which she had formerly 
invested the supervisor lessened, she showed less need to be 



SUPERVISOR AND STUDENT 93 

superior or dominant in her contacts with her clients and to 
impress them with her wisdom and experience. She increas- 
ingly developed more warmth and a less intellectualized atti- 
tude in relation to them. In the supervisory conference, in- 
stead of seeking to present a definite plan of what she was to 
do, she began to question how she could create an atmosphere 
that would make it possible for the clients to bring out what 
they were concerned about. 

In working with this student as with any beginning stu- 
dent, the supervisor's general objectives (as for example giv- 
ing an "all-round" case experience so far as this was adminis- 
tratively possible) were not lost sight of, but the attempt was 
made consistently to relate these objectives to the individual 
needs of the student in such a way that she could assimilate 
and make use of them. 

Many examples could be quoted of students, inexperi- 
enced in case work, who showed much the same need to assert 
their independence and opposition to individuals who they 
felt were in positions of authority. There were as many, per- 
haps more, instances in this group as well as in the group of 
more experienced students, who showed a tendency to be- 
come very dependent on the supervisor at the beginning of 
the training period. Perhaps unconsciously, many supervisors 
have a tendency to consider this type of response natural for 
the student who is not only inexperienced in case work but 
also very young. In such a student they may recognize de- 
pendent attitudes earlier and handle them more successfully 
than when the student is older and more experienced. To 
what extent this may have been a factor in training at the In- 
stitute it is impossible to say because reports were as a rule 
not sufficiently detailed in respect to supervisory processes. 

Certain reports more full than others, however, give evi- 
dence of how problems of dependency were approached by 



94 TRAINING IN PSYCHIATRIC SOCIAL WORK 

the supervisor, as in the following example of a student who 
was about thirty at the time of entering. This student had 
had a mixed background of professional experience, partly in 
the case work field and partly in teaching, before coming to 
the Institute. She brought to her training experience the very 
real assets of a keen interest in people, sensitivity, and an 
alert, inquiring mind, qualities which it was felt should en- 
able her to develop more than average ability in the practice 
of psychiatric case work. Although she had a certain quality 
of independence on the intellectual level, the student showed 
a marked insecurity in her adjustment to the unfamiliarities 
of the case work approach in this clinic set-up and an emo- 
tional need to lean upon someone whom she could consider 
secure and experienced. Since the student had had consider- 
able satisfaction in her earlier case work situation, she was 
assigned, at the start of her training, cases similar to those 
with which she had formerly worked, and was encouraged by 
the supervisor to talk out with her the problems and implica- 
tions for treatment as she saw them in as much detail as she 
wished. Because of the student's readiness and eagerness to 
get all the counsel she could, it was possible for the super- 
visor to inject into the discussions a good deal of her own 
thinking and case work philosophy in simplified terms. In 
this way she provided patterns for the student to follow at 
this early stage of her understanding of social psychiatric 
concepts. The student's wholesome tendency, even at this 
point, to question the supervisor's thinking and to wish to test 
it by her own experience before integrating it as part of her 
philosophy, was thought to be symptomatic of a certain 
amount of essential security in her emotional adjustment. On 
this account it was believed that she could be emancipated 
from her early dependency fairly readily. 

The inadvisability of attempting such an emancipation too 



SUPERVISOR AND STUDENT 95 

abruptly, however, was clearly demonstrated in the second 
quarter of her training. At this time, the supervisor, aware 
that the student's dependency was tending to increase and 
questioning the value of continuing her close methods of su- 
pervision, attempted to encourage the student to have more 
reliance on her own evaluations of case situations and on her 
ability to meet the needs of her clients in the treatment rela- 
tionship. The student reacted to this at first with some hos- 
tility to the supervisor, showing reluctance to do her own 
thinking and turning to the psychiatrist with requests for as- 
sistance in terms of concrete suggestions as to what she should 
say or do. At this point, the supervisor, relying on her convic- 
tion of the fundamentally sound nature of the relationship 
that had earlier been built up between her and the student 
and of the satisfaction and growth within certain recognized 
limits that the latter had shown in it, approached the student 
rather directly and asked her if she had tried to interpret the 
causes of her present reactions. The student showed no resist- 
ance to attempting this and discussed freely the emotional 
implications of the situation into which, she discovered, she 
had considerable insight. She was encouraged to use the su- 
pervisory conferences for more thoughtful, planned discus- 
sions in which she might assume an increasing amount of re- 
sponsibility for enriching the understanding of her cases. She 
was also urged to make more productive her opportunities 
for getting the benefit of group thinking on her cases. From 
this time on, her progress in personal growth and under- 
standing and in her ability to handle successfully her rela- 
tions with her clients was on the whole much more consistent 
and commensurate with her superior personality equipment. 
To the experienced supervisor these examples will serve to 
recall many other varied and interesting student responses to 
the training experience. The few detailed illustrations given 



96 TRAINING IN PSYCHIATRIC SOCIAL WORK 

in this report were not selected because they were outstanding 
in any way, but rather because they represented significant 
and fairly usual reactions. In future studies of training, this 
whole subject may well be considered worthy of greater 
elaboration. 

One and two quarter students. In attempting to integrate 
successfully the experiences of the students from the New 
York School who were at the Institute for only one or two 
quarters of training, it was important to keep in mind the 
kind of adaptations they would be called upon to make later 
in other fields. Few if any of them, presumably, would go 
into positions in a psychiatric clinic. For the most part, then, 
the supervisors and staff at the Institute tried to help the 
short-term students to achieve a better understanding of 
some of the basic concepts of social psychiatry, not so much 
to guide them in dealing with problems of emotional unad- 
justment on an intensive basis as to give them a background 
for evaluating such problems. Such equipment, it was hoped, 
would help to make them more discriminating in their future 
jobs in selecting cases to be referred to a psychiatric clinic, or 
those for whom other types of available community service 
could be successfully utilized. In other words, this clarifica- 
tion of understanding often helped the student to achieve in- 
sight into what it was better "not to do," as much as it helped 
her to handle emotional difficulties on a deeper level. 

It was important, too, that these students should grow in 
their ability to integrate theory with practice, so as to be able 
to interpret to co-workers or others in schools, communities, 
etc., some of the concepts underlying social psychiatry. Al- 
though this ability to serve as interpreter to the community 
was an essential part of any student's equipment, it is espe- 
cially emphasized in relation to the one and two quarter stu- 
dents, because being difficult to attain in such a short period 



SUPERVISOR AND STUDENT 97 

of training, it represented for the supervisors one of the ob- 
jectives which particularly tested their skill. Keen discrimina- 
tion was required to select and coordinate the individual's 
experiences so as to offset as far as possible the difficulties 
arising in a situation where the slower and more normal de- 
velopment of growth processes, possible in a longer training 
period, had to be telescoped. 

Specific and concrete methods often utilized for enriching 
the experience of these short-term students were the follow- 
ing: the assignment of several new cases on which examina- 
tions in all four fields were yet to be made, as early in the 
students' experience as possible} the assignment of a number 
of old cases nearly ready for closing ; and the assignment of 
closed cases on which follow-up visits were due. 

The values of the new case have been so frequently dis- 
cussed in the preceding pages that further elaboration does 
not seem indicated here. Old cases about ready for closing 
and follow-up on closed cases offered an opportunity for 
study and evaluation of treatment relationships over long 
periods of time without the necessity for intensive treatment 
at the moment^ yet the material thus utilized had a certain 
dynamic quality because of the fact that the students had ac- 
tual contacts which served to vitalize the situations and to keep 
them from seeming academic and theoretical. A sufficient 
number of such cases was not always available for assign- 
ment, and moreover the needs of the agency sometimes made 
it necessary to give short-term students old cases to be carried 
on an intensive treatment basis, in spite of the disadvantage 
of establishing contacts with a new worker when only a brief 
relationship could be maintained. 

An attempt was made to utilize as many consultation cases 
as possible for the short-term students, and work on their 
own assigned cases was supplemented by the reading of those 



98 TRAINING IN PSYCHIATRIC SOCIAL WORK 

of other students. Cases for reading were selected from those 
which presented health or financial problems, outstanding 
difficulties in school adjustment, and so on, according as the 
student's major interests were in medical social service, 
family case work, or visiting teaching. In the supervisor's dis- 
cussions, it was often possible to clarify for the students the 
essential similarity in the approach of any case worker to 
these problems, as well as the occasional somewhat different 
emphases in a psychiatric clinic, brought about through the 
different "point of entry" 5 into the situation. Such discussion 
was often especially productive when it could be arranged to 
have the students first attend group conferences on the cases, 
thus making the material of more current and vital interest. 
Attendance at group conferences on cases other than their 
own was encouraged for the short-term students more than 
for others, in order to familiarize them with the group 
method of interpreting and planning treatment on as wide a 
spread of case situations as possible. The importance of read- 
ing cases in advance of the conference was consistently 
stressed. 

Methods Used in the Qualitative Evaluation of Student 
Work 

In addition to the monthly statistical reports, summarized 
quarterly, which the supervisor kept for each student and 
which gave figures for volume of student work (see Chapter 
VI), narrative reports were also made containing a qualita- 
tive as well as a quantitative measure of work. Such reports 
were needed to clarify the staff thinking, as well as to furnish 
the schools with information on their students. Because of the 

5 For amplification of the theory of case work specialization on the basis of point 
of entry into the case, see Changing Goals of Psychiatric Social Work, by Christine 
C. Robb, The News-Letter of the American Association of Psychiatric Social Workers, 
I: 1-6 (July, 1931). 



SUPERVISOR AND STUDENT 99 

plan of the New York School to divide the year into quar- 
ters, it was logical that they should wish to have some orien- 
tation on the students at the completion of each of these 
periods. The Smith College School, which made no such 
division of time, at first requested a very brief monthly re- 
port, but after 1930 was interested in receiving a fuller quar- 
terly report, similar in general content, if not in detail, to 
that sent the New York School. 

Some supervisors, when first faced with the necessity to 
include interpretation as well as factual data on volume of 
work, were distrustful of their ability to keep reports com- 
pletely objective and free from some element of identifica- 
tion or rejection. The proceeding became more acceptable, 
however, when the tentative nature of the reports was un- 
derstood and it was made clear that only what the student 
seemed capable of doing at any given point should be re- 
corded, and not generalizations as to her qualifications. Even 
though it was essential to keep such reports tentative, it was 
recognized that in all fairness to the students, they should 
represent the greatest possible degree of clear thinking on the 
part of the supervisors. Obviously the careful process of 
evaluating the student's strength and weaknesses assisted the 
supervisor in steering the student through the training ex- 
perience in such a way as to give her the maximum benefit 
from it. The supervisors became increasingly interested in re- 
fining their techniques for analyzing student reactions to the 
training situation and in writing the narrative reports, so that 
these might become a valuable contribution to the building 
up of a successful supervisory relationship. 

One of the supervisors, in experimenting with reporting as 
an aid to supervision, devised a chart which she kept weekly, 
checking off on it an estimate of the student's progress in the 
utilization of her abilities, roughly grading these for conven- 







1st C 




2nd ( 


3rd 




1. Intellectual capacity 


A 


B 


C 


A 


B 


C 


A 


B 


C 


2. Maturity of thought 




















5. Judgment and discrimination 




















4. Awareness 




















5. finotional acceptance of supervision 




















of subject matter 




















6. Social approach: 
timidity-authority range 




















7. Sensitivity 




















8. Subjectivity-objectivity 




















9. Stability 




















10. Sustained effort 
spasmodic or consistent pace 




















11. Ability to gain rapport 




















12. Ability to maintain rapport 




















15. Physical condition 




















14. Leadership 




















15. Organization sense 




















16. Planfulness 




















17. Responsibility 




















18. Grasp- and use of psychiatric concepts 




















of psychological concepts 




















of medical concepts 




















19. Appreciation and utilization 
of social resources 




















20. Interview technique 




















21. Record writing 




















22. Tempo 




















* 

II 

rf 


Cases 




















Contacts 




















Hours reading 




















Hours analysing and recording 




















Hours interviewing 




















Hours transportation 




















24. 1 


niperficial or intensive 




















Total impression 





















SUPERVISOR-STUDENT CHART USED TO EVALUATE QUALITY OF 
STUDENT WORK 



IOO 



SUPERVISOR AND STUDENT IOI 

ience as above average, A, average, B, or below average, C. 
The points checked corresponded with the main headings on 
the outline of the reports sent to the New York School, and 
were reasonably representative of the essential factors to be 
considered in an evaluation of the student's work. The objec- 
tive here, as indicated above, was to become better equipped 
to judge when the student should be given more responsi- 
bility and freedom, when she needed more help and less 
pressure of responsibility, etc. The average for any student 
was roughly gauged by balancing the checks in the above and 
below average columns, unless the average predominated. 
Not all points checked were considered to have equal value 
and this was taken into account in calculating averages. For 
example, in the first or even second quarter, those ratings in- 
dicating assets or liabilities in personality equipment for case 
work were considered more important than those indicating 
success or failure in utilization of social psychiatric concepts. 
It was, however, of the utmost importance, even in the early 
part of training, for the supervisor to keep constantly in- 
formed as to the use the student was making of her abilities 
in order to gauge her adjustment in the training situation, 
and the clarification of this relation afforded by the chart was 
its principal value. The chart was found to be such a useful 
source of immediate orientation to the student's needs, that it 
was later adopted by several others in the supervisory group. 
It was used in the evaluation of the students of the Special 
Study Groups, 6 the results being employed in making com- 
parisons of students' work on a qualitative basis. 

One could not expect complete uniformity and unanimity 
on the part of the supervisors in the application of these 
measures. Partly on this account, but principally because it is 
obviously impossible to tabulate and classify the behavior and 

6 See chapter vi. 



IO2 TRAINING IN PSYCHIATRIC SOCIAL WORK 

abilities of human beings except in very relative terms, the 
evaluations by the Institute staff were never considered to 
have more importance or validity than the rough approxima- 
tions at which we arrive in measuring other individuals with 
whom we come in contact. We are constantly being measured 
with a yardstick of some sort; and in turn we are making our 
own deductions as to the abilities and achievements of others. 
If, in their attempts to measure the students, the staff felt a 
special responsibility to be as objective and as understanding 
as possible, they were nevertheless well aware of how tenta- 
tive, at best, and how very relative their conclusions must be. 
The scepticism felt by many in using the chart was un- 
doubtedly a healthy factor, since it prevented any tendency 
to accept the values emerging as other than suggestive. The 
evaluations represented in general the opinion of two people, 
since for the most part they were made out in collaboration 
by the supervisor and by the educational supervisor. 

In order that the terms used in the chart should be uni- 
formly understood and interpreted, they were brought up 
for discussion at a conference of supervisors. The definitions 
arrived at on this occasion were compiled and amplified by 
Miss Charlotte Towle, the originator of the chart, and are 
given below. 

Terms Used in the Supervisor-Student Chart 

i. Intellectual capacity. Ability to grasp theoretical con- 
cepts ; ability to think logically in terms of cause-and-effect 
relationships; ability to analyze case material not only in 
terms of cause and effect, but also with a differentiation be- 
tween basic and superficial factors; ability to see the parts in 
relation to the whole without losing sight of the whole in 
relation to the parts. In a training situation it can be assumed 
that every student has good intellectual capacity, or she 



SUPERVISOR AND STUDENT IO3 

would not have qualified for training. We are concerned, 
then, with some rough evaluation of the finer gradations in 
the intellectual capacity of intelligent individuals, in so far 
as they react to the thinking involved in social psychiatry. 
When we speak of a student as having above average, aver- 
age, or below average intellectual capacity, we are not using 
these terms with their generally accepted values in psycho- 
logical testing; instead, we are using them with reference 
only to the thinking of a selected group in a particular field. 

2. Maturity of thought. This is a somewhat controversial 
point. Perhaps it is safe to assume that mental immaturity 
does not preclude good intellectual capacity; that is, there is 
not necessarily a correlation between maturity of thinking 
and intellectual capacity. While immaturity is usually emo- 
tionally determined, there are not in all instances concurrent 
acute emotional issues noted in the individual's adaptation. 
For clarification, the following examples are given. 

Student Number One had an adequate grasp of theoretical 
concepts in this field. She was mentally alert; in fact, had 
made good grades in college and had considerable academic 
drive. Her thinking was childish, however; that is, her phi- 
losophy of life as revealed in case discussions showed com- 
plete acceptance of traditional concepts and platitudes, with 
no tendency to analyze or criticize existing social customs or 
traditional points of view, especially concerning family rela- 
tionships. Immature thinking would probably be character- 
ized by adherence to platitudes, prejudices, acceptance of 
dogma, and a tendency to premature generalizations. Some- 
times this inability to think independently might be due to 
limited intelligence. In this instance, however, it seemed to 
have originated in emotional dependence on parents with 
whom she was completely satisfied because her relationship 



IO4 TRAINING IN PSYCHIATRIC SOCIAL WORK 

with them had been more pleasurable than unpleasurable. 
This student, when exposed to concepts of the cause-and- 
effect relationships underlying human behavior was essen- 
tially untouched. She seemed to grasp the new concepts theo- 
retically, but did not incorporate them into her thinking or 
show any tendency to think more independently. While her 
level of thinking had been emotionally determined, still she 
brought to the training situation a mental immaturity which 
might be more clearly understood apart from the factor of 
emotional immaturity, for not all emotionally immature in- 
dividuals present the problem of mental immaturity. For 
example: 

Student Number Two was emotionally immature though 
intellectually mature; that is, she showed a capacity to think 
independently, to challenge platitudes, prejudices, and 
dogma, and to be very tentative and discriminating in her 
generalizations. From the intellectual standpoint she was 
sufficiently divorced from the concepts handed down to her 
by her parents and society to be able to evaluate objectively 
certain philosophies which she could accept, and certain 
others which she could not accept. When it came, however, 
to the application and utilization of her freedom in thinking, 
she was emotionally too tied to her parents to achieve much 
independence of action. This student was emotionally imma- 
ture, in spite of considerable mental maturity. In the training 
situation she presented the problem of acute emotional con- 
flict, for she was constantly frustrated in her attempt to real- 
ize emotionally what she could conceive intellectually. 

3. Judgment and discrimination. Judgment is defined as 
"the operation of the mind, involving comparison and dis- 
crimination, by which knowledge of the values and relations 
of things is mentally asserted or formulated. It implies wise 



SUPERVISOR AND STUDENT IO5 

and discriminating perception or discernment" (Webster). It 
is recognized that a student's capacity for judgment and dis- 
crimination may be affected by emotional involvement. 

4. Awareness. This term should be confined in usage to 
mental implications, as Item 7 covers sensibility or emotional 
awareness. It includes consciousness of self, as well as aware- 
ness of that which is perceived as outside the self. It there- 
fore includes the quality of autocriticism, seeing oneself and 
being conscious of what one is doing in a situation. It implies 
being mentally awake or conscious of the reactions of others. 

5. Emotional acceptance of supervision. This implies that 
a student reveals little or no resistance to the supervisor as an 
individual or to the guidance or counsel which she offers. 

Emotional acceptance of subject matter. This indicates the 
absence of resistance to the concepts, viewpoints, and evalua- 
tion of human behavior in the particular training situation. 

6. Social approach. Qualities of timidity or authority as 
evidenced in the student's handling of people. The term may 
also imply in this connection some evaluation of her use of the 
direct and indirect approaches, as growing out of a tendency 
to be timid or over-authoritative. The discussion on pages 
216-227 of Mental Hygiene and Social Work 1 describes the 
usage of these terms by the Institute staff. 

7. Sensitivity. Delicacy and susceptibility of feeling. This 
term implies the capacity to identify with other individuals 
in experiencing their feeling tones, or in conveying or occa- 
sioning an emotional response in them. It is used in referring 
to the handling of case work situations rather than the per- 
sonal or subjective sensitivity of the worker in the sense of 

7 By Porter R. Lee and Marion E. Kenworthy, M.D. (New York: The Common- 
wealth Fund, 2d ed., 1931). 



IO6 TRAINING IN PSYCHIATRIC SOCIAL WORK 

being easily affected, quick to take offense, etc., qualities 
which are included under Item 8, Subjectivity-objectivity, 
in these evaluations. It is interesting to note the degree of 
correlation between mental awareness and sensitivity. It is 
noted that students frequently have an acute sensibility about 
when to do or not do something with, however, little mental 
consciousness as to why, and with little awareness that they 
have actually been discriminating. 

8. Subjectivity-objectivity. In case work, by objectivity is 
meant the capacity to deal with a situation or with another 
person without allowing judgment to become distorted by 
emotions. Subjectivity implies the opposite} i.e., the tendency 
to become emotionally involved in dealing with a situation 
or person so that the judgment may seem impaired. For a 
full discussion, see Mental Hygiene and Social Work, pages 
235240. It is of interest to note the degree of correlation 
between this capacity and Item 5, Emotional acceptance of 
supervision and of subject matter; also between it and Items 
I, 2, and 3 Intellectual capacity. Maturity of thought, and 
Judgment and discrimination. 

9. Stability. This pertains to the student's personality ad- 
justment. It involves steadiness of purpose, constancy, adapt- 
ability} that is, a capacity for withstanding emotional upsets. 
A student's capacity to carry on at an even pace, without un- 
dergoing tension or periods marked by emotional strain, is 
considered an indication of stability. Stability does not pre- 
clude questioning and challenging of theoretical concepts. It 
may not imply necessarily complete acceptance of subject 
matter or supervision, though it is interesting to observe the 
degree of correlation between stability and these factors. It 
is of interest also to observe the relation between stability and 
Subjectivity-objectivity; in fact the relation of stability to 



SUPERVISOR AND STUDENT 

practically any or all of the remaining factors may be re- 
vealing. 

10. Sustained effort. Is a student spasmodic or consistent 
in the application of her efforts? Does she work by fits and 
starts or at an even, consistent pace? This item is of particular 
interest in regard to Stability and Subjectivity-objectivity. It 
is also of interest in relation to Tempo (Item 22). It is recog- 
nized that there may not be a correlation between this fac- 
tor and Tempo for a slow person may work at a consistent 
pace, or she may be very spasmodic in her effort. Likewise, a 
very rapid worker may be either consistent or spasmodic. 

11. Ability to gain rapport. 

12. Ability to maintain rapport. The meaning of these 
terms is self-evident. The correlation between the two is of 
particular interest. Frequently it is noted that those indi- 
viduals who gain rapport very readily do not have the ca- 
pacity to sustain it. The degree of correlation between these 
points and Items 8, 9, 18, and 20 Subjectivity^objectivity, 
Stability y Grasp and use of psychiatric concepts^ arid Inter- 
view technique is of interest. 

13. Physical condition. This should be taken into account 
when the student's physical condition seems to have a definite 
bearing on her training reactions. Protracted absences due to 
illness inevitably affect productivity and may affect stability 
and other reaction phases. Chronic illness or "not feeling up 
to par," even though it has not involved absence, should be 
noted. 

14. Leadership. In a real capacity for leadership, as the 
term is used here, executive qualities formerly stressed are 
now minimized. The student's capacity to utilize the indirect 



IO8 TRAINING IN PSYCHIATRIC SOCIAL WORK 

approach in stimulating self -activity in others as well as ca- 
pacity to make a permanent contribution in engendering re- 
sourcefulness and independence are now stressed as essential 
elements in leadership. The student who secures and main- 
tains strong rapport so that her patients follow her unques- 
tioningly is not showing a real capacity for leadership, if the 
relationship has been so satisfying that it is not readily 
shifted to others on her departure, or if the patients do not 
gradually gain some capacity to function apart from her. 
Leadership is often difficult to gauge because the real quality 
of it is sometimes not demonstrated until a student's depar- 
ture. There may be indications of this, however, as for ex- 
ample: one student, who had overemphasized the relation- 
ship on a personal basis, remarked that no one would be able 
to take over her cases. A check in the capacity for leadership 
may seem to be offered in evaluations of Awareness, Sensi- 
tivity, Stability , Subjectivity-objectivity, and Grasp and use 
of psychiatric concepts. For a fuller discussion of leadership 
see Mental Hygiene and Social Work, pages 243-245. 

15. Organization sense. By this is meant both an aware- 
ness of the implications for the individual of working within 
an organization, and a disposition to conform to the require- 
ments of organized activity. The term implies adherence to 
policies and regulations of the organization, willingness to 
work through other channels, and an ability and willingness 
to enter into the team work of the organization. It includes 
also the readiness with which a student conforms to routine 
matters, such as cooperating in statistical reporting, recording, 
and other so-called "red tape" details. 

1 6. Planfulness. This term is not to be confused with Or- 
ganization sense. It applies to planfulness in case work} that 
is, how resourceful the student is in making plans and in 



SUPERVISOR AND STUDENT IO9 

adapting plans to meet emergencies or shifts in treatment 
emphasis. What Lee and Kenworthy term "range" 8 would 
be included in our understanding of planf ulness. 

17. Responsibility. The degree to which the student shows 
a capacity to assume responsibility for her case work, her of- 
fice work, her planning, and working with others in all as- 
pects of the job. 

1 8. Grasp and use of psychiatric concepts. The grasp of 
psychiatric concepts and ability to utilize those concepts in 
practice implies an interplay of Items i, 2, 3, and 4 with 
Items 5, 7, 8, 9, 1 1, and 12, that is, an interplay between the 
intellectual and emotional equipment of the individual. Un- 
der Item 2, Maturity of thought^ two student cases were 
cited. Student Number One could be said to have had a 
limited grasp of and a limited ability to utilize psychiatric 
concepts. Student Number Two had an unusually good grasp 
of psychiatric concepts but very limited capacity for utilizing 
them. An effective worker would maintain a nice balance be- 
tween a good grasp of psychiatric concepts and a growing 
capacity to utilize them. It may be said that having gained a 
good grasp of these concepts a student should show a gradual 
growth in the utilization of them and probably will, unless 
there is some emotional involvement. In considering grasp 
and use of psychological and medical concepts the same 
thinking would apply. An effective worker does not tend to 
overweight any of these fields in a given case situation but 
shows an appreciation of all three, both in grasp of concepts 
and in utilization of the same. Examples of significant reac- 
tions showing some imbalance follow. A student may bring 
to the training situation the preconceived idea that behavior 
problems are primarily related to mental deficiency. Given a 

8 Op. cit. 



IIO TRAINING IN PSYCHIATRIC SOCIAL WORK 

mentally retarded case, she may tend to overlook the psy- 
chiatric factors both in her evaluation and in treatment. 
Many students are so engrossed in the psychiatric implica- 
tions that they overlook the physical factors in study, evalua- 
tion, and treatment. A student may have a particular interest 
in physical health as it affects mental health. One may find 
such a student overstressing the physical factors, particularly 
in treatment. 

19. Appreciation and utilization of social resources. By 
this is meant a student's appreciation of the contribution 
which outside resources can make to the study, evaluation, 
and treatment of her cases, and her ability to use these re- 
sources. It includes her capacity to make good contacts with 
the workers of other organizations so as to gain their interest 
and cooperation in working with her, in accordance with the 
needs of a case. The potentiality for developing community 
wisdom and the ability to relate one specialized field of social 
work to others are important factors in this qualification. 

20. Interview technique. This capacity is very difficult to 
evaluate. It can only be indirectly gauged from the student's 
written reports of her interviews and her verbal accounts of 
them, together with the amount and type of information se- 
cured, against which one can check the subsequent reactions 
of her patients. The ability to gain and maintain rapport may 
reflect the interviewing skill in some instances. Some stu- 
dents, however, because of personality make-up, may gain 
and maintain rapport without any great degree of interview- 
ing skill. For example, one frequently reads an interview in 
which the student has been very blunt, and theoretically one 
would feel that her method of approach was very threaten- 
ing to the client. The subsequent reaction of the client, how- 
ever, suggests that good rapport with the worker was estab- 



SUPERVISOR AND STUDENT III 

lished which offset and negated the threats implied in her 
recording of the interview. In some such instances the utiliza- 
tion of a direct and rather threatening approach may have 
been conscious ; that is, the student may have been aware of 
her role and sensitive to the client to such an extent that she 
was able to evaluate how far she could go in utilizing this 
approach profitably for the client. In other instances, there 
may have been no awareness or sensitivity on the part of the 
worker. The approach may have been haphazard but because 
of the student's "way with people" no negative reaction oc- 
curred. However, this haphazard method usually is not effec- 
tive in all of a student's cases, though it may get by in some. 
Therefore, the observation of the student's accounts of inter- 
views as they develop, checked against the reactions of her 
patients in a number of cases, should give some estimate of her 
facility in interviewing. What constitutes skill in interview- 
ing is not defined, and it is believed that there is no generally 
applicable formula. If a student secures material essential to 
diagnosis, prognosis, and treatment without endangering the 
relationship of the client to her or to the clinic, she can be 
credited with possessing skill, whether or not her facility is 
based predominantly on a conscious technique, is the result of 
a sensitive handling of her relationship with a minimum of 
conscious control, or combines both emphases. 

21. Record writing. The training goal in record writing 
is for the student to develop the ability to write clearly, 
concisely, and comprehensively, with discrimination as to 
when and where not to elaborate. Records can be used as one 
of the illuminating sources of information with regard to 
the student's qualities and capacities in general. They should 
throw light on the major points covered so far, but particu- 
larly on such factors as: Intellectual capacity. Maturity of 



112 TRAINING IN PSYCHIATRIC SOCIAL WORK 

thought. Judgment and discrimination) Awareness y Emo- 
tional acceptance of supervision and subject matter. Subjec- 
tivity-objectivity) Leadership) Planfulness y Grasp and use of 
psychiatric concepts, and Interview technique. Through her 
records the supervisor gets to know the student and her work. 
The articulate student, therefore, is at a great advantage. 
When a student is inarticulate or when she is confused and 
disorganized in her writing, one is immediately led to con- 
sider what is contributing to this problem. Observation of the 
degree of correlation between this capacity and others may be 
of particular interest. The development of a viewpoint and 
conviction with regard to the purposes of detailed recording 
and the possibility of adapting this to work in future jobs is 
often a prerequisite to satisfactory record writing. 

22. Tempo. This is the term used to describe the pace at 
which a student works. It may or may not correlate with 
Sustained effort. Lee and Kenworthy 9 discuss tempo in rela- 
tion to temperament. It is interesting to note its correlation 
with other capacities and qualities -, for example, when a stu- 
dent is going through a period of rejection of subject matter 
or supervision, is her tempo slow? Is it accelerated with the 
clearing of these problems? Does it correlate with Stability) 
with Subjectivity-objectivity in like manner? The relation 
between tempo and the extent to which a student's work is 
superficial or intensive is also of interest. 

23. Volume of work. While provision is made for check- 
ing this in terms of size of case load carried, numbers of con- 
tacts made, and hours spent in reading, analyzing, and re- 
cording, as well as in interviewing and transportation, it is 
recognized that considerable uniformity of opinion, now 
often lacking among supervisors, as to what constitutes a 

9 Op. cit. 



SUPERVISOR AND STUDENT 113 

normal balance between quantitative and qualitative output is 
needed before this item can be legitimately included in the 
evaluation of a student's ability to profit by the training situa- 
tion. Unless outstanding difficulties are shown by a student in 
handling volume of work, this item may be omitted. 

24. Level of case work carried; superficial, intensive. The 
term level applies to the quality of case work and not to the 
type of service. Intensive indicates an average or above aver- 
age ability to do sensitively discriminating case work 5 super- 
ficial indicates a below average ability. Ordinarily there is a 
direct correlation between this item and all the others, with 
the exception of Item 23, since the focus of evaluation 
throughout is on the progressive utilization the student 
makes of her intellectual and emotional equipment in rela- 
tion to case work. The chart is an index of the quality of 
work the student is achieving, as well as a guide to the super- 
visor as to specific areas where her strength and weakness lie 
at different points in training. 



VI 

VOLUME AND QUALITY OF 
STUDENT WORK 



IN surveying the richly suggestive material accumulated 
during the years of the operation of the Institute, in the 
form of statistical and narrative reports on the work of the 
students, it was thought that an analysis of the volume and 
quality of student work might prove revealing, especially to 
those concerned with supervision and with the selection of 
student candidates. Specifically, the points with which this 
analysis is concerned are: (i) volume of work, for which the 
index utilized here is case load and case contacts, 1 and rela- 
tion of volume of work to the student's experience and age 5 
(2) quality of work, for which the index utilized is the su- 
pervisor's evaluation of the student's progress in the training 
situation, 2 and relation of quality of work to the experience 
and age of the student; (3) relation of volume of work to 
quality of work; (4) comparison of the work of the students 
from the Smith College School with that of students from the 
New York School. Interest in the last point developed from 
the necessity of studying the reports of students from each 
school separately, in evaluating their work, since differences 
in length of student training under the plans of the two 
schools made analysis of the volume of work of the student 
body as a whole impossible. 

The question which is often raised as to the advantages 

1 Figures on volume of work were taken from the statistical reports on individual 
students referred to in chapter v, page 98. 

2 These evaluations were taken from the individual student records on the super- 
visor-student chart described in chapter v, pages 99113. 



VOLUME AND QUALITY OF STUDENT WORK 115 

and disadvantages implicit in the field work systems of the 
two schools is on the whole a speculative and theoretical one. 
We have little real evidence that a student finds it more 
profitable to approximate a job situation while in training, as 
she does under the Smith School plan, without prolonged in- 
terruptions of classes and class preparation and the consequent 
emotional shift} or that by dividing her time between classes 
and field work, the New York School student gains greater 
stimulus and resulting acceleration in growth from the very 
fact that theory and practice are concurrent and not successive 
experiences, thus providing a ready means of testing each in 
relation to the other at every step in case work practice. It is 
probable that this somewhat intangible issue did somewhere 
enter in to influence the psychology of the two groups. 
It may be of interest to see how it affected volume and direc- 
tion of activity as shown in the comparisons of the work of 
the students of the two schools. 

Individuals responsible for training often tend consciously 
or unconsciously to identify themselves with the students of 
one level of age and experience or another, and on that basis 
to develop a point of view that students fitting into this 
group are the best equipped to profit by training. Others may 
accept the concept that a student's age or experience is of im- 
portance only in so far as she has utilized these factors to re- 
inforce the healthy or unhealthy trends in her emotional pat- 
terns, but may question whether these factors usually operate 
to facilitate or to retard the adjustment to training. For ex- 
ample, the values of greater flexibility and enthusiasm usu- 
ally associated with youth, on the one hand, and of the mas- 
tery of a bulk of knowledge and technical processes funda- 
mental to case work ordinarily associated with the somewhat 
older and more experienced worker, on the other, are often 
discussed as if they had an intrinsic importance, aside from 



Il6 TRAINING IN PSYCHIATRIC SOCIAL WORK 

other considerations. Because of this, it was thought of inter- 
est to get an actual picture in an agency during a period of 
several years of the volume of work carried by students of 
different ages and backgrounds of experience. 

The relation of quantity of output to quality of work is a 
point which one still finds questioned by supervisors, admin- 
istrators, and others. Probably there would be general agree- 
ment that except in a very special type of agency in which, 
for example, intensive service is given on a few cases for re- 
search purposes, pressure of work makes it imperative that a 
worker, even a student, approximate at least a certain tenta- 
tive norm in size of case load and number of cases carried in 
intensive treatment. It may then be of interest to see how 
averages of volume of activity taken from the statistical re- 
ports in the years 1928-1932 compare among students dis- 
tributed according to the supervisors' estimate of their ability 
to do skilful case work. 

Basis of Selection of the Special Study Group 

In attempting to make any sort of evaluation of the work 
of the students, it was necessary to make a selection of those 
who had some uniformity in length of the training period. 
The Smith College School students constituted a relatively 
consistent group for statistical evaluations, since the students 
annually spent three quarters, or approximately nine months, 
at the Institute and gave about four and a half days a week 
to field work. 3 The New York School group, however, pre- 
sented many complexities, because of the plan of training at 
this school which resulted in students entering the Institute 
at the beginning of any one of the four quarters, and remain- 

3 Although the Smith College School students were commonly rated as full time 
(working five and a half days a week) the actual amount of time available for field 
work, after deductions had been made for other required activities, was equivalent to 
about four and a half days a week. See chapter ii, page 28. 



VOLUME AND QUALITY OF STUDENT WORK 

ing, according to the further flexible provisions of this plan, 
for periods varying from one to four quarters, during which 
they worked from two to five and a half days a week. 4 More- 
over, the Smith College School students entered the Institute 
in September instead of October (the beginning of the New 
York School fall quarter), giving the former group the ad- 
vantage of approximately one additional month of training, 
in a three quarter period. 

It will be recalled that the two largest groups of New 
York School students who had been at the Institute for com- 
parable lengths of time were the one quarter students, who 
came on a three day a week schedule, and the three quarter 
students, who also had three days a week of field work 
throughout the three quarters (see Chapter II, page 28). Be- 
cause it lent itself better to comparison with the Smith Col- 
lege School students, the group of three quarter students was 
the one used in the study. 

In order to insure further uniformity by obtaining as com- 
parable material as possible, the students in training during 
1927-1928, the first year of the Institute's existence, were 
omitted from the group studied, for the reason that training 
during the early period was less well formulated and stand- 
ardized in its general structural aspects than it was afterward. 
Also, no students were included who were at the Institute 
during the year 1932-1933, because the general retrench- 
ment in the scope of work, due to administrative plans for 
closing the agency, made the training situation during that 
year atypical. 

During the four-year period (1928-1932) under consid- 
eration, there were 57 students who qualified for the Special 

4 After October, 1929, no students were accepted for Institute training on a basis 
of less than three days a week. But see chapter ii, pages 27 and 28, for the variation in 
the schedules of the New York School students. 



Il8 TRAINING IN PSYCHIATRIC SOCIAL WORK 

Study Group from the Smith College School, 5 and 33 from 
the New York School. 6 While it is recognized that deductions 
based on such small numbers are not statistically significant, 
it was thought that the quantitative and qualitative aspects of 
these students' work would be of value as fairly representa- 
tive of student work at the Institute. 

Grouping of Students by Length of Case Work Experience 
and by Age 

Students included in the Special Study Group were di- 
vided into three groups, A, B, and C, according to the length 
of their case work experience before entering the Institute 
for Child Guidance. Such experience had been largely in the 
fields of family work, child placing, medical social work, and 
visiting teaching under progressive auspices well standard- 
ized as to case work practice. Relatively few students had had 
previous experience in psychiatric case work. Professional ex- 
perience other than case work was not considered in the tabu- 
lation although some students had spent periods varying 
from a few months to ten or more years in such activities as 
teaching, nursing, club and community work, psychological 
testing, statistical work, and visiting teaching on a superficial 
level, unstandardized as to case work practice. 

The distribution of the Special Study Group and the stu- 
dent group as a whole, from each school, according to length 
of previous case work experience, is shown in Table 3. 

Since, except in the case of very young students, there is no 
necessary correspondence between experience and age, the 
students were further divided into four groups on the basis 

5 Six of the Smith College School students present at the Institute from September, 
1928, to June, 1932, were omitted from this study because of lack of reports. In ad- 
dition, four others were omitted either because they dropped out before the end of 
the year or because they had long periods of absence on account of illness during the 
year, and their work was therefore not comparable with that of the full time students. 

6 The actual number of students was 24, but for reasons explained in the appendix 
the number is treated in the statistical analyses as 33. 







6 


l^>. C4 M O 




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in N N O 




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TABLE 3 


NGTH OF CASE WO 
STUDENTS FROM 


NEW YORK SCHOOL 

y Group All Stut 

ER CENT NUMBER 


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I2O TRAINING IN PSYCHIATRIC SOCIAL WORK 

of age. The students twenty-two years old or younger were 
grouped together because, presumably, they came to the 
training experience either directly from college or with at 
least a minimum of experience in professional work, so that 
the student role at the Institute would follow naturally for 
them in the sequence of recent and familiar experiences. The 
second group included the students between the ages of 
twenty-three and twenty-nine because, on the whole, they 
might be considered as having worked with varying degrees 
of success since college without having been faced with the 
same need to take inventory of their achievement or failure 
and future prospects as might be expected of older indi- 
viduals. The third group covered the ages thirty to thirty- 
five because during this period it might be anticipated that 
students would be less flexible in making an adjustment to 
training than the younger students unless they had utilized 
their previous experience of success or failure to further their 
growth personally and professionally. Whether they were 
less able than younger students to identify with a new or- 
ganization, to accept mental hygiene concepts, and to adjust 
to the student role, was a possibility that it seemed of interest 
to consider. The age of the fourth group was set at thirty-six 
years and over because students at that age may often be con- 
sidered as doubtful material for acceptance in any training 
center. This older group would always presumably be com- 
posed of individuals who had been working from ten to fif- 
teen or more years, who had established certain pretty defi- 
nitely formulated techniques and philosophy, and had perhaps 
gained considerable prestige in their own field and commu- 
nity. For them readjustment to work in a new and specialized 
field, under supervision, would require a degree of objec- 
tivity in exposing themselves to criticism, a readiness to be 
experimental, and a willingness to be guided without react- 





g 


o \o ^o oo o 




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to ^ M O 




s s 


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-i* 




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o i^ * 




5 


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W 
Q 


8 3 

W 2 


N tO M Oo 




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ft ^i H 




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g 


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g g 


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M TJ* t<^ M O 


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TABLE 

AGE. SPEC] 
LOM BOTH 


JCHOOL 

All Stud, 

NUMBER 1 


e< oo vO to o 

M 


S^ " 


tt 




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^ 


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N to O vO ^ 
r< N ^o o C*H 



121 



122 TRAINING IN PSYCHIATRIC SOCIAL WORK 

ing toward supervision either with resentment or overde- 
pendence, which at this age would be unusual even in a rela- 
tively stable individual. 

The distribution of the Special Study Group and the stu- 
dent group as a whole, from each school, according to age 
classifications, is shown in Table 4. 

From Tables 3 and 4 it may be seen that there was a 
greater predominance of relatively inexperienced students 
and of younger students from the Smith College School than 
from the New York School, both for the total group and for 
the Special Study Group. 

It is interesting to note that the bulk of the students from 
each school fall in the age range between twenty-three and 
twenty-nine years. However in the Special Study Groups, 
about one fourth (23 per cent) of the students from the 
Smith College School were 22 years old or younger, while this 
age group represented only about one sixteenth (6 per cent) 
of the New York students. One half of the Smith College 
School students (49 per cent) in the Special Study Group 
had had less than one year of case work experience, thus fall- 
ing into the A experiential group, whereas the students of 
the New York School Special Study Group were predomi- 
nantly of the C type of experience, 58 per cent falling under 
this heading. 

The only significant difference between the total groups 
and the Special Study Groups may be found in the distribu- 
tion by experience for students from the New York School. 
The high proportion of most experienced students found in 
the New York School Special Study Group was not charac- 
teristic of the Institute students from that school as a whole, 
who show a practically even distribution among the three ex- 
periential groups. 

The correlation between age and experience is shown for 



VOLUME AND QUALITY OF STUDENT WORK 123 

the Special Study Groups in Table 5 (Smith College School) 
and in Table 6 (New York School). It is of interest that the 
least experienced group, A, was not composed exclusively of 
the youngest students but included students of all ages. As 

TABLE 5 

DISTRIBUTION OF STUDENTS BY LENGTH OF CASE WORK 

EXPERIENCE AND BY AGE. SMITH COLLEGE 

SCHOOL SPECIAL STUDY GROUP 



AGE 


EXPERIENCE 


Total 
group 


22 years 
and under 


23 to 29 
years 


30 to 35 
years 


36 years 
and over 


A. Less than one year 












or none 


28 


12 


H 


2 





B. One to three years 


H 


I 


ii 


I 


I 


C. Three years or more 


15 


- 


4 


6 


5 


Total group 


57 


13 


20 


9 


6 



TABLE 6 

DISTRIBUTION OF STUDENTS BY LENGTH OF CASE WORK 

EXPERIENCE AND BY AGE. NEW YORK SCHOOL 

SPECIAL STUDY GROUP 



AGE 

Total 22 years 23 to 29 30 to 3$ 36 years 
EXPERIENCE group and under years years and over 



A. Less than one year 










or none 


9 * 


5 


I 


2 


B. One to three years 


5 i 


2 


2 


- 


C. Three years or more 


19 


13 


6 


- 


Total group 


33 ^ 


2O 


9 


2 



124 TRAINING IN PSYCHIATRIC SOCIAL WORK 

might be expected, however, by far the greatest proportion 
of the students in this group were under thirty. 

Volume of Work: Use and Significance of the Term 

In the following pages volume of work is shown by fig- 
ures on size of case load, distribution of old and new cases, 
and amount of work done on them by the students, as far as 
this can be measured numerically by total case contacts and 
focus of contacts for intensive treatment. Such figures are 
utilized as a measure of volume of work, since they are com- 
monly used in making such estimates and because it is practi- 
cally impossible within the scope of this study to analyze all 
the activities which occupied student time. (See Tables i and 
2, Chapter II, pages 37 and 38, for summary of distribution 
of student time.) 

In order to arrive at any clear understanding of the signifi- 
cance of these figures, however, it is essential to consider 
some of the factors which condition them, exclusive of the 
individual student's needs and capacities. The average of 
total cases assigned, and the proportionate distribution of 
cases old and new, are points of general interest to those re- 
sponsible for student training. To some extent these figures 
as presented here reflect the average student's capacity for 
work in the sense that the attempt was made at the Institute 
to assign cases as fast as was commensurate with the student's 
ability to absorb and profit by them. In actual practice, how- 
ever, it is probable that case assignment was influenced by 
other factors than the student's capacities, and it would seem 
unsound, even in the light of wide variation in ability, to ac- 
cept without qualification the figures on case load as indica- 
tive of pace set by the individual. 

Some of the conscious and unconscious factors that tended 
to affect the size of case load may be briefly noted. The 



VOLUME AND QUALITY OF STUDENT WORK 125 

standard set by the most adequate students in successive years 
undoubtedly tended to influence the supervisor, even though 
perhaps largely unconsciously, as to the number of cases 
which she could attempt to handle herself in the expectation 
of relatively prompt reassignment to her students. More- 
over, the supervisor, in taking stock of the cases for which 
she was responsible, was necessarily to some extent guided in 
planning increase or decrease of case load by her own capaci- 
ties and limitations in handling volume of work. For ex- 
ample, her own case load was affected by the general struc- 
tural policies of the Institute, by which those in training in 
all fields participated in the team work handling of cases. 
The number of supervisory conferences involved in work on 
any case with a student, plus the number of group confer- 
ences entailed, also limited the supervisor's total case load, 
as well as the occasional demands on her for case work in the 
absence of the student or in periods between reassignment of 
cases. She naturally could not assign to the students more 
cases than she could adequately supervise. Other important 
factors operated to influence the expansion or curtailment of 
the case load of individual students: the total number of cases 
accepted by the Institute for treatment 5 the number of cases 
closed} and the pace set by the psychiatrists and psychologists 
in training, by other students in social service, and by the staff 
members. It would be impossible to gauge with any degree of 
accuracy the effect of the interaction of all these factors: 
how far, for example, the acceptance of a saturation point 
for psychiatric or psychological service influenced social serv- 
ice, and vice versa ; how far these considerations influenced 
intake for the agency, especially in terms of cases accepted 
for brief consultation service rather than for intensive treat- 
ment y and how far efforts to stimulate new applications for 
treatment or to remain passive in regard to them influenced 



126 TRAINING IN PSYCHIATRIC SOCIAL WORK 

the situation. It is probable, however, that through the years 
of the Institute's experience there was a gradually evolving 
norm, never consciously recognized or articulated, of the 
number of cases to which adequate treatment could be given 
at any time under the conditions of a team work relationship, 
and that this norm tended to standardize case load directly 
for the agency and indirectly for the individual at a level 
that may or may not have been commensurate with the lat- 
ter's capacity. 

In evaluating individual capacities, figures on contacts 
should be regarded with as much suspicion as those on cases. 
In a psychiatric clinic such as the Institute, although intensive 
case work was stressed as important, there is always the need 
for careful discrimination as to the level of treatment on 
which a given case should be carried. Consultation cases on 
which a few treatment contacts may be made prior to closing, 
and treatment cases in which brief service adequately meets 
the needs of the situation, are of equal importance with the 
cases carried in relatively long-time treatment to the clinic, 
in its double responsibility to client and training program. 
In the latter cases, whether the major responsibility for 
therapy is carried by the psychiatrist or the social worker, or 
whether the responsibility is shared, evaluations of move- 
ment in the case may indicate at any point that a shift of 
treatment responsibility to the other therapist would be ad- 
visable because of resistances shown either consciously or un- 
consciously by the client. To a lesser extent such a shift of 
treatment responsibility might be necessitated by practical 
considerations of time available in one field though not in the 
other, if it was possible at the same time to safeguard the in- 
terests of the client. If major responsibility is transferred to 
the psychiatrist, this tends to reduce the number of contacts 
by the social worker. The number of contacts may also be re- 



VOLUME AND QUALITY OF STUDENT WORK 127 

duced if responsibility for intensive treatment on the basis of 
frequent interviews is diminished. This happens when an ob- 
jective appraisal of case movement indicates that the indi- 
viduals looked upon as key persons in the situation are nearly 
ready to assume responsibility for handling their relation- 
ships with others, without help from the clinic, and to take 
over responsibility for others in the family group less ready 
to become self -determining and independent. Closed cases on 
which follow-up visits are made represent situations in which 
as a rule a worker makes only one or two contacts. 

From this discussion of contacts it may be seen that on 
many cases carried by students there will not be an average of 
one contact a week, and that in such instances as those noted 
above this is due to discrimination in meeting case situations, 
and not to incapacity on the part of the worker. In other in- 
stances, infrequent contacts on a case may be indicative of the 
worker's inadequacy in carrying forward treatment. More- 
over, sometimes a piling up of contacts to a point where the 
average on a case is considerably more than one a week, may 
be symptomatic of a student's need to keep busy, and inability 
to handle the basic needs of the case. Within the limits of this 
study, no effort was made to analyze the individual student's 
case load with the aim of discovering whether the number of 
contacts per case seemed adapted to the type of service re- 
quired. Cases on which there was an average of at least one 
treatment contact a week over a considerable period of time 
were listed as intensive treatment cases in conformity with 
the general usage of this phrase in this book (see Chapter II, 
page 1 8). Pre-staff intensive service was measured in terms 
of four or more contacts, as representative of the usual pro- 
cedure in obtaining the social examination, in distinction to 
the special consultation cases on which in general not more 
than one and rarely two pre-staff contacts were made. 



128 TRAINING IN PSYCHIATRIC SOCIAL WORK 

When so many factors unrelated to the ability of the stu- 
dent influence the number of contacts and cases, it may be 
questioned what the real values are which emerge from a 
quantitative estimate of students' work. It is believed that an 
analysis of the volume of work carried by the average stu- 
dent in training at the Institute may furnish a point of de- 
parture for others in planning student activity and may lead 
to a more economical and profitable distribution of student 
time within the limitations set by the requirements of the 
agency. It should be remembered, however, that some of the 
conditioning factors, exclusive of the individual student's 
own needs and capacities, which influenced case assignment 
and contacts on cases at the Institute, might have been to 
some extent altered or modified had the agency continued. 
Obviously as a result of progress in training methods, similar 
modifications may occur in other agencies in the future. For 
instance, more time might be released for the student so that 
she could handle a larger case load and carry a larger propor- 
tion of cases in intensive treatment. This, indeed, would be 
the logical outgrowth of refinement of techniques involved 
in supervision and in the team work relationship and of the 
development of criteria for treatability, closing of cases, etc. 
In a field of activity where so many important elements defy 
analysis and classification, it is perhaps all the more important 
not to disregard those relatively measurable factors which, if 
fully understood and interpreted in the light of all their im- 
plications, may contribute something to our store of wisdom 
and skill in making the training experience a more profitable 
one. 

Experience and Age related to Volume of Work 

Table 7 shows the average number of cases, case contacts, 
and cases carried on the basis of intensive work in the three 







w 


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H O 52; H 



I3O TRAINING IN PSYCHIATRIC SOCIAL WORK 

quarters for all the students of the Smith College School 
Special Study Group and for the three classifications accord- 
ing to experiential background. Table 8 presents similar mate- 
rial regarding volume of work for students of the New York 
School Special Study Group in relation to age. 7 In the first 
quarter, the term Intensive treatment, 'post-staff is applied to 
cases having had at least eight rather than twelve contacts, 
since in the initial period of orientation relatively few con- 
tacts were made. 

On the tables showing volume of work, the figures for 
Total cases assigned. Old treatment cases, total, and New 
cases, total in the second and third quarters are cumulative 
and represent the entire average load of treatment cases car- 
ried forward from the preceding quarter and including those 
assigned in the given quarter. Cases that may have been 
closed during that period are also included. 8 Closed cases as- 
signed only for follow-up visits are not included in the fig- 
ures for old and new cases, so that the sum of the averages of 
these cases often does not equal the average for total cases 
assigned. The figures for Total contacts and cases carried in 
Intensive service, pre-staff and post-staff represent the work 
for the given quarter only. 

Intensive service was distinguished from other service by 
the minimum of contacts mentioned above. However, it 
should be kept in mind that the minimum number of contacts 
was sometimes far below the actual number of contacts made 
on cases carried in intensive service. It might happen that a 
case would have as many as 30 or 40 contacts during a quar- 
ter. On the other hand, large numbers of contacts were rare 
on pre-staff cases, and when two or more siblings were 
treated simultaneously, it was arbitrarily determined to count 

7 Each of these tables corresponds closely with the same type of table which was 
made out for the other school. For this reason only one table is given from each school. 

8 See chapter iii, page 44, for definition of old and new cases. 







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132 TRAINING IN PSYCHIATRIC SOCIAL WORK 

only the contacts for one sibling to avoid overlapping. Obvi- 
ously, the total number of contacts, as shown in the table, is 
higher than if only the minimum number of contacts appor- 
tioned to the cases listed as intensive service were repre- 
sented. 

Examination of Tables 7 and 8 shows that the average 
volume of work varies in the three quarters. Interesting 
variations, as might be anticipated as the students progressed 
in training, are in the average number of total contacts (for 
example, for the Smith College group, 71 in the first quarter, 
107 in the second, and 128 in the third) and in the average 
number of total cases assigned (for example, for the New 
York School, 8.1 in the first quarter, 13.3 in the second quar- 
ter, and in the third, 16.3). Progressively during the three 
quarters the number of new cases showed an increase, while 
the number of old cases remained about the same through- 
out, bringing about in the last quarter an essential balance be- 
tween old and new cases. 

While the figures on cases carried in intensive service are 
low, they are included in the tables for their suggestive value 
to those concerned with training. The variety of types of 
service given by student social workers, previously discussed, 
accounts to a large extent for the fact that relatively few 
cases were carried on an intensive treatment basis. In other 
words, the number of consultation cases, cases in which major 
responsibility was carried by the psychiatrist or psychologist, 
old cases nearly ready for closing, and so on, tended to some 
extent to keep contacts at a relatively low figure. The many 
other varied demands on the student's time, equally impor- 
tant to her progress in relating theory to practice, also influ- 
enced the number of contacts (see Chapter II, page 31). 
However, it is important to bear in mind the fact that these 
figures represent an actual and not an ideal situation, and that 



VOLUME AND QUALITY OF STUDENT WORK 133 

a constant effort was being made in Institute training to refine 
the techniques of treatment service in order to meet more 
effectively the needs of the case, and on this basis to clarify 
concepts of what might be considered a reasonable average 
volume of work per student per quarter, and what propor- 
tion of this should be work on cases carried on intensive 
service. 

The data presented in Tables 7 and 8 show no correlation 
between the volume of work carried in each quarter and the 
age and experience of the students. From the average figures 
for groups A, B, and C in Table 7, representing degrees of 
experience, it might appear that in the second quarter there is 
a trend toward slightly higher volume of work for the C 
students in the matter of total case contacts. The difference in 
averages, however, was found to be statistically insignificant. 9 
All other averages for the A, B, and C groups shown in these 
tables are markedly similar within each quarter. Further- 
more, the fact that there was no significant difference be- 
tween the average volume of work for the total group of stu- 
dents and that of the groups distributed according to age or 
experience is suggestive that these factors were not of intrin- 
sic importance in determining increase or decrease in quanti- 
tative production among the Institute students. In other 
words, no matter how often age and experience were utilized 
unconsciously by the students to play into their emotional 
patterns, thus helping or handicapping them in their work 
according to the nature of the emotional determinants, there 
was no curve of distribution shown in the tabulation to sug- 
gest that there was higher incidence of either constructive or 
destructive trends operating in the personality adjustment of 
students in one age or experience group rather than another, 

9 See page 143 for discussion of the scattering of individual records and the over- 
lapping of distributions which invalidate the significance of the differences in the 
averages. 



134 TRAINING IN PSYCHIATRIC SOCIAL WORK 

so far as this may be gauged by capacity to carry an average 
volume of work. 

It is of very real interest that, as the figures for the total 
groups show in Tables 7 and 8, the plan of the New York 
School, providing division of time between class work and 
field work, furnished the opportunity and the stimulus to the 
students from this school to approximate so nearly the vol- 
ume of work carried by the Smith students, although the lat- 
ter had considerably more time allotted to them. The aver- 
age number of total cases and of intensive treatment cases 
was very nearly the same, but the New York School students 
aggregated fewer contacts. As we have already noted, 10 the 
average amount of time recorded for interviewing was ap- 
proximately the same for students from both schools. 

There are no adequate data available to determine 
whether, as seems possible, the Smith College School stu- 
dents with more time available for field work were at a dis- 
advantage by not having more cases. However, comments 
made by students regarding their personal training experi- 
ence as they viewed it in retrospect at the time of leaving are 
of interest. Since they were not obtained from all the stu- 
dents, it would perhaps be unsound to place too much value 
on the comments made, but it may be significant that on the 
whole the majority of students from the New York School 
reported that they had worked under considerable pressure 
and had as many cases as they felt could be handled with any 
degree of adequacy. On the other hand, the majority of stu- 
dents from the Smith College School stated that they had 
felt relatively little pressure and would have been able to 
carry more cases. 11 

Since, in general, it appeared to those responsible for case 

10 For figures on distribution of student time see chapter ii, pages 37 and 38. 

11 These comments were taken from reports of student interviews in the year 
193132 when the average case load was the same for both groups. 



VOLUME AND QUALITY OF STUDENT WORK 135 

work at the Institute that the needs of the clients were being 
met reasonably satisfactorily (within the limitations of thera- 
peutic advancement as understood at the time by the staff), 
the probabilities are that an increase in size of case load could 
have been adequately handled, without sacrificing quality, by 
students who had as much time for field work as those from 
the Smith College School. The difficulty of carrying larger 
numbers of cases because of the necessary cooperation with 
the other clinical divisions, discussed on page 125, was un- 
doubtedly a factor in slowing up intake of cases. 

Experience and Age related to Qualify of Work 

Psychiatrists and psychiatric social workers will always be 
concerned chiefly with the quality of student work rather 
than with the quantity. Therefore, an attempt was made to 
estimate this and students included in the Special Study 
Group from both schools were classified by quality of work, 
according to their supervisors' estimates of their progress" in 
the training situation, as above average, average, or below 
average. Since such estimates were made quarterly, the num- 
ber of students in each group would necessarily change from 
one quarter to the next, shifts in evaluation being made in suc- 
ceeding quarters in accordance with the abilities or limitations 
revealed by the students in the course of training. Since many 
of the difficulties inherent in adjustment to a new situation 
are necessarily most marked in the first months, it was recog- 
nized that attempts to classify students' work in the first 
quarter should be considered even more tentative than in 
later quarters, and that ordinarily a considerable proportion 
of students who were in the below average group at first 
would later make very satisfactory progress in developing 
their potentialities for more adequate case work. 

12 See chapter v, pages 99-113. 



136 TRAINING IN PSYCHIATRIC SOCIAL WORK 

The distribution of students in the Special Study Group in 
the three quarters according to this tentative classification is 
shown in the first row of figures in Tables 1 1 and 1 2 (pages 
141 and 142). 

Because of the difference in opportunities and objectives 
in training, the three quarter students were not comparable 
in terms of progress in the training situation with the one and 
two quarter students. It was not possible, therefore, to com- 



TABLE 9 

DISTRIBUTION OF STUDENTS BY EXPERIENCE AND BY 

QUALITY OF WORK. SMITH COLLEGE SCHOOL AND 

NEW YORK SCHOOL SPECIAL STUDY GROUPS 

Total EXPERIENCE 

QUALITY OF WORK group ABC 

Smith College School 

All students rated 57 28 14 15 

Above average 32 14 8 10 

Average 17 10 4 3 

Below average 8422 

New York School 



All students rated 


33 


9 


5 


19 


Above average 


16 


5 


4 


7 


Average 


H 


4 


i 


9 


Below average 


3 








3 



pare the figures in the tables with supervisors' evaluations for 
the total group of 289 students. But it is interesting to note 
that within the Special Study Groups of the two schools there 
is relatively the same proportion of above average, average, 
and below average students in the last quarter, about half 



VOLUME AND QUALITY OF STUDENT WORK 137 

rating as above average and only a very small proportion rat- 
ing as below average. These figures are significant in estimat- 
ing both the personality equipment of students accepted for 
training and the qualifications of the students who left the 
Institute technically prepared to apply for positions in a psy- 
chiatric agency. 



TABLE IO 

DISTRIBUTION OF STUDENTS BY AGE AND BY QUALITY 

OF WORK. SMITH COLLEGE SCHOOL AND NEW 

YORK SCHOOL SPECIAL STUDY GROUPS 



QUALITY OF WORK 


Total 
group 


22 years 
and under 


AGE 
23-29 
years 


30-35 
years 


3 6 years 
and over 


Smith College School 


All students rated 


57 


13 


2 9 


9 


6 


Above average 


3* 


7 


17 


5 


3 


Average 


17 


3 


8 


4 


2 


Below average 


8 


3 


4 


- 


I 






New 


York School 






All students rated 


33 


2 


20 


9 


2 


Above average 


16 


I 


7 


6 


2 


Average 


H 


I 


ii 


2 


- 


Below average 


3 





2 


I 






The distribution of students in the Special Study Groups 
from both schools by experience and quality of work and by 
age and quality of work as estimated by the supervisors, is 
shown in Tables 9 and 10. No correlation is shown between 
quality of work and age or between quality of work and pre- 
vious experience. 



138 TRAINING IN PSYCHIATRIC SOCIAL WORK 

It is true that we have no established norm for measuring 
personality and capacity for dealing sensitively and objec- 
tively with human beings. There was undoubtedly consider- 
able variation among the supervisors in their estimates of the 
students' ability to utilize the training experience and ade- 
quacy in case work. There would be no justification, there- 
fore, in putting too much weight on these evaluations. If, 
however, the tabulations are considered as suggestive of 
trends, they may be of real help in clarifying our thinking 
concerning the relation between quality of work and experi- 
ence and age. 

Qualify related to Volume of Work 

Ability to carry an ordinary case load is obviously a de- 
sirable asset both to the student and to the center where she 
is in training. Frequently the supervisor or others responsible 
for training may overlook the quantitative aspects of a stu- 
dent's work because of preoccupation with so many other as- 
pects of training: building up the student's techniques in the 
handling of case work relationships, emphasis on community 
aspects of the job, etc. On the other hand, supervisors may 
place a tremendous emphasis on speeding up and increasing 
the volume of clinic service without appreciation of the indi- 
vidual student's ability to carry an ordinary case load and 
with a consequent lowering of the standard of case work. 
Fortunately, as time went on, there was at the Institute an in- 
creasing balance between two such extremes. 

There are often situations, however, in which it is particu- 
larly difficult to reconcile the training needs of the student 
and the demands of clinic service. Even a seemingly well 
established balance may be disturbed by such normal changes 
as result from a growing awareness on the part of the com- 
munity of the resources the clinic affords for help with its 



VOLUME AND QUALITY OF STUDENT WORK 139 

problems, and the pressure on a progressive clinic staff to 
raise its standards of case work. Presumably up to a certain 
point these demands are not conflicting. It is conceivable that 
an agency may establish a norm for volume of work which 
does not threaten the quality of it, and may expect by and 
large an approach to this norm in the work of its staff mem- 
bers, students, and fellows. If there should be a more con- 
scious tendency in training toward this sort of balance, a 
future criterion of a student's capacity for case work of a 
superior quality may have to be more closely related to an 
increasingly high standard of output before a student is esti- 
mated as above average in her capacity. On the other hand, 
pressure for quantitative output may in the future be offset 
by the growing trend in many case work agencies to adopt a 
type of therapeutic approach which demands so great an ex- 
penditure of the therapist's time that case load must be re- 
duced unless a method is devised of terminating therapy 
within a few weeks. 

All changes in concepts of social psychiatric therapy will 
naturally modify the theories which govern the training of 
social service students in psychiatric clinics or elsewhere. The 
Institute, while adhering in the main in its training program 
to the policies of the team work approach to case work, was 
continuously influenced by the changes in the philosophy of 
case work of other agencies and by all the psychological fac- 
tors operating in the community as a result of the increased 
pressure on case work agencies which the financial depression 
brought about. Certain of these factors tended to influence 
the clinic in the direction of higher standards of both quality 
and volume of case work. Concurrently with this tendency, 
other factors operated to increase the number of cases and 
thus to bring about a still higher volume of work, in some in- 
stances, perhaps, at the sacrifice of quality of work. On the 



I4O TRAINING IN PSYCHIATRIC SOCIAL WORK 

other hand, the need for higher quality of work was some- 
times stressed at the expense of output. In spite of such 
conflicting tendencies, a sufficiently integrated surface level 
was apparently maintained in adjusting the balance between 
volume and quality to insure stability in the training pro- 
gram and adequate response to the community's requests. 
Within the limits of this study it has not been possible to 
show how far these trends affected volume of work year by 
year, either for the group or for the individual; nor has an 
attempt been made to analyze the extent to which they influ- 
enced the supervisor's estimate of student ability. 

Because of the lack of agreement among the supervisors 
and others concerned with training as to a tentative norm for 
volume of work, it was not possible to lay emphasis on this 
item in making evaluations of progress by means of the su- 
pervisor-student charts. 13 The relation of volume of work 
and quality of work remained on the whole undefined until 
analyzed in the course of this study. 

Figures for the volume of work carried by the students of 
each Special Study Group, as a whole and as divided into 
classifications according to the supervisors' estimates of the 
quality of their work, are given in Tables n and 12. They 
show that the number of cases carried and the number of con- 
tacts made by each group within each quarter are approxi- 
mately the same. Apparently, for the Special Study Groups, 
quality has no direct relation to average volume of work. It 
would seem, therefore, that there was little tendency on the 
part of the supervisors to adjust volume of work to the stu- 
dent's ability, a finding which is confirmed by the fact that the 
average volume of work for the total group from each school 
did not vary from the average volume of work carried by 
each group distributed by the supervisor's estimate. 

13 See chapter v, pages 99113. 









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142 



VOLUME AND QUALITY OF STUDENT WORK 143 

Individual Variations underlying Group Averages 

In interpreting the data presented in the tables, certain 
features underlying the averages must be kept in mind. The 
small number of students included in each group has already 
been referred to. While this makes the data of slight value 
statistically, they are none the less interesting as authentically 
indicating trends. What of course does not appear in the 
tables but is shown on the accompanying charts was the wide 
variation in the number of cases carried and contacts made on 
cases by the individual students in any one group, and the ex- 
tensive overlapping of the individual records in the various 
groups. This extensive overlapping of group distributions as 
a constant feature of the students' records is illustrated in 
Charts I, II, and III. 

As an example of the interpretation of these factors in 
comparing averages and drawing conclusions about group 
differences, the situation presented graphically in Chart I is 
interesting. The chart describes the distributions of the indi- 
vidual records of case contacts which are represented in the 
averages for the three experience groups of the Smith School 
Special Study Group in the second quarter. From the aver- 
ages shown for experience groups A, B, and C in Table 7, it 
would appear that a higher volume of work as indicated by 
total case contacts in the second quarter was recorded for the 
C students than for the other two groups. As will be seen 
from the diagram, the distribution of contacts made by the 
C students in the second quarter and the distributions of the 
contacts of A and B students overlap considerably. Many A 
and B students made more contacts than the C group average, 
and correspondingly several C group students recorded fewer 
contacts than the averages of the A and B groups. Two stu- 
dents in the A group made considerably more contacts than 
any of the C students. The wide scatter of the records in each 



TRAINING IN PSYCHIATRIC SOCIAL WORK 

group with extensive overlapping of the distributions of indi- 
vidual records accounts for the fact that from a statistical 
point of view the small differences between the averages of 
the three groups are not significant. 









EXPERIENCE 

A 


1 I i 1 1 I 1 i 1 1 1 1 1 ! 1 
S 




(18 STUDENTS) 

B 


A 





<4 STUDENTS) 
Q 


A 




( 15 STUDENTS) 


A 
1 1 I 1 1 1 1 1 1 I I 1 ! 1 1 




5 


O 00 70 60 90 IOO 1)0 120 130 140 150 l6o 170 l8o 190 2OO 

NUMBER OF CONTACTS 

INDICATES RECORD OF ONE STUDENT 
A INDICATES THE AVERAGE 





CHART I. DISTRIBUTION OF NUMBER OF CASE CONTACTS IN THE SEC- 
OND QUARTER AS RECORDED FOR THE STUDENTS OF THE SMITH COL- 
LEGE SCHOOL SPECIAL STUDY GROUP, CLASSIFIED BY EXPERIENCE 

Though group averages for volume of work as shown in 
the tables presented in this chapter were markedly uniform, 
there was rather wide variation in numbers of contacts for 
individual students of the Smith College School Special 
Study Group, as we have seen in studying the sample Chart 

I. This is true also of the New York School students (Chart 

II, number of contacts related to age, third quarter). A simi- 
lar wide range of individual records was found in the num- 
ber of cases carried in the different groups, as shown, for ex- 



VOLUME AND QUALITY OF STUDENT WORK 145 

ample, in Chart III (Smith College School students, number 
of cases related to supervisor's estimate, third quarter). Such 
variation, it is interesting and suggestive to note, indicates 
that the Institute policies and philosophy of case handling 



AGE 

22 YEARS AND UNDER 
( 2 STUDENTS) 

23 TO 29 YEARS 
(20 STUDENTS) 

30 TO 34 YEARS 

(9 STUDENTS) 

35 YFAR.S AND OVER 
(2 STUDENTS) 

9 

INDICT 
A 1NDIC/ 






1 I 1 1 1 1 1 1 J 1 1 


A 


A 

: : : 


A 
1 1 1 1 1 I 1 1 1 1 1 


O 40 60 80 IOO I2O 140 


TES RECORD OF ONE STUDENT 
LTES THE AVERAGE 





CHART II. DISTRIBUTION OF NUMBER OF CASE CONTACTS IN THE 

THIRD QUARTER AS RECORDED FOR THE STUDENTS OF THE NEW 

YORK SCHOOL SPECIAL STUDY GROUP, CLASSIFIED BY AGE 

had only a limited influence on standardization of work for 
the individual. And whatever the actual factors were that 
contributed to this variation in quantity, in the study of this 
group of Institute students no trend has been shown to sug- 
gest that age, experience prior to entry, and ability in case 
work from a qualitative standpoint were of intrinsic impor- 
tance. How far individual variation in volume of work can 
be controlled in the training situation to the profit of both 
cases and students, is a subject for further study. The uni- 



146 



TRAINING IN PSYCHIATRIC SOCIAL WORK 



QUALITY 






OF WORK 

ABOVE AVERAGE 


I I 1 I I l I i I i I I I I 



: : : : 




(3* STUDENTS) 

AVERAGE 


1 




07 STUDENTS) 
BELOW AVERAGE 


i 




(8 STUDENTS) 


t t t A t f 

l l 1 I I 1 1 1 1 1 1 1 I 1 






A 


11 11 13 14 IJ l6 17 l8 IQ 20 21 22 2] 24 
NUMBER OF CASES 

INDICATES RCCORD OF ONE STUDENT 
INDICATES THE AVERAGE 





CHART III. DISTRIBUTION OF NUMBER OF CASES ASSIGNED IN THE 
THIRD QUARTER AS RECORDED FOR THE STUDENTS OF THE SMITH 
COLLEGE SCHOOL SPECIAL STUDY GROUP, CLASSIFIED BY SUPER- 
VISOR'S ESTIMATE OF QUALITY OF WORK 



formity in the average volume of work of the different 
groups studied is suggestive that the factors underlying indi- 
vidual variations elude generalization and group analysis. 
Some light may be thrown on these factors in the brief dis- 
cussion of individual students given in Chapter VII. 

Statistical Recording of Training Activities 

While the findings based on the statistical data in this 
study have been negative, in that significant differences have 
not been shown between the work of different groups of stu- 
dents, such findings are obviously as important for purposes 
of clarification of our thinking on factors influencing student 



VOLUME AND QUALITY OF STUDENT WORK 147 

adjustment to training as if the data had revealed trends in- 
dicative of differences. If we accept the fact that analysis of 
statistical data for groups of students has only a limited value 
in revealing broad trends in regard to adjustment to training 
the importance of such analysis is still apparent. 

In an evaluation of students' work by means of a statistical 
analysis of volume, for example, we have one important 
means of estimating the focus and direction of their efforts. 14 
Certain values unquestionably do accrue in case work from 
frequent contacts, even in some instances when these are on a 
superficial level, although they are obviously particularly 
important in carrying a case on a more intensive treatment 
level. It is part of the supervisor's responsibility to keep in- 
formed on this aspect of training no less than any other, and 
to estimate from it whether her students may be scattering 
their efforts in contacts on too many cases, or whether they 
are planning contacts wisely to yield their greatest value by 
focusing them on cases which need to be carried on a basis of 
weekly interviews. In fair case work accounting we can no 
more afford to underestimate such values when they exist 
than we can afford to inflate them beyond the point where 
they are an index of substantial achievement. While probably 
any evaluation of this sort to be of greatest help to the super- 
visor would have to be done on an individual basis, it is open 
to question whether group figures might not be made more 
telling by relating numbers of contacts to cases; for example, 
by presenting numbers of contacts per month, for a group, in 
terms of intensive or scattering, those which represented 
weekly contacts on a given case falling under the first head- 
ing, all others to be classified as scattering. If this method 

14 For a method of recording contacts and service, see Recording and Reporting 
for Child Guidance Clinics , by Mary Augusta Clark (New York: The Commonwealth 
Fund, 1930), chapter vii. 



148 TRAINING IN PSYCHIATRIC SOCIAL WORK 

proved successful in focusing the attention of the clinical 
group on trends in treatment, as it seems logical to anticipate, 
it presumably would be of help not only to the supervisors 
in revealing areas in which the students might or might not 
need more guidance but also to the administrative division in 
controlling intake of treatment cases versus cases for consul- 
tation only, and so on. 

Without statistical records of clinical work, undoubtedly 
certain real values would be lost for it would be difficult to 
maintain even the flexible standard essential in a clinical set- 
up for handling intake with any degree of adequacy. Any 
administrator must be in a position to quote figures on cases 
accepted, referred to the different types of service, closed, 
treated, etc. Furthermore, in order to do intelligent planning 
for future work he must know in general terms what volume 
of work may be handled on an intensive treatment basis with 
a certain number of available staff members, either perma- 
nent or in training. There will undoubtedly, therefore, al- 
ways be a place for figures as one method of making a rough 
estimate of such factors. However, in psychiatric organiza- 
tions, perhaps especially in those functioning in connection 
with other branches of medicine where concrete specific serv- 
ices are stressed and tabulations of services are therefore 
more significant, there has sometimes been a tendency to 
place more value on the record of work done than was justi- 
fiable. 

Though it is very important that the supervisor should 
constantly relate the student's statistical report of her case 
load and case contacts to her general progress in the training 
situation, caution should be exercised in the utilization of 
such statistical summaries. How necessary it is that exposi- 
tional reports of students' work should fully interpret the 
statistics which they include perhaps becomes more clearly 



VOLUME AND QUALITY OF STUDENT WORK 149 

understood in the light of the data and the conclusions pre- 
sented in this study. 

Concluding Comments 

It would obviously be impossible on the basis of the figures 
presented in this chapter to make any formulations as to the 
volume of work which a student should carry while in train- 
ing. A standard for volume of work must remain relative 
and dependent on the agency's dynamic and changing con- 
ception of its case work responsibility. However, periodic 
evaluations of the kind attempted here should be useful in 
disclosing whether current theories of the general amount of 
work that the agency should undertake correlate with actual 
practice ; and if and where significant deviations from the 
norm tentatively established by the total group occur. In such 
analyses, the range of numbers of cases carried or of con- 
tacts made will also necessarily be of interest, and investiga- 
tion into individual extremes either in overproduction or 
underproduction may be revealing in relation not only to stu- 
dent work but to supervision and balance in team work. Some 
of the training implications in the approximations to or devia- 
tions from the average volume of work of the Special Study 
Groups will be discussed in the following chapter in connec- 
tion with the experience of individual students. 

While extremes in volume of work, the very high as well 
as the very low, should probably always be open to suspicion, 
ability to keep up to the norm may not necessarily mean any- 
thing more than an ability to keep up to pressure in case 
handling and may reveal nothing else of importance in rela- 
tion to the effectiveness of the worker, as the comparisons of 
volume and quality have shown in the case of the Special 
Study Groups. 

All the students in social service who took their training at 



I5O TRAINING IN PSYCHIATRIC SOCIAL WORK 

the Institute were to a certain extent a picked group. This 
fact must always be kept in mind in an analysis of their work, 
though it should not obscure the issue here, since our primary 
concern has been to discover what the Institute experience 
might contribute to improve the techniques of selection of 
students in order to achieve increasingly careful discrimina- 
tion. At this point we are prepared to say that the statistical 
analysis of the Institute's experience in student training sub- 
stantiates our concepts of the primary significance of indi- 
vidual variation in ability to utilize one's capacities, and the 
relative unimportance of records of the succession of life ex- 
periences except as we understand how they have played into 
the individual's emotional pattern, either increasing or de- 
creasing his needs and his adequacy in handling his relation- 
ships with others. 



VII 

EXAMPLES OF INDIVIDUAL TRAINING 
EXPERIENCE 



IN order to get a more complete picture of the interplay of 
the quantitative and qualitative factors in achievement, a 
few examples of individual student experience will be briefly 
discussed. 

Although in general no correlation was found to exist be- 
tween quantity and quality of student work when groups of 
students were studied (Chapter VI), it was recognized that 
in individual instances subjective factors must influence vol- 
ume as they obviously do influence quality. Furthermore, it 
was recognized that in the future in training centers it should 
be possible to bring about a relatively consistent and satisfac- 
tory adjustment of quantity to quality of student work in re- 
lation to the volume and type of service the agency is at- 
tempting to furnish. This may be done if the supervisors are 
more constantly on the watch for the emotional implications 
of increase or decrease in volume of work, the deviation being 
measured in terms of a more clearly defined, though neces- 
sarily tentative, norm for case work handling than many 
agencies have worked out for themselves in the past. 

It was found in analyzing the tables in Chapter VI that the 
average for volume of work was approximately the same on 
the majority of counts for the Special Study Groups from 
both schools, thus establishing what may be taken as a tenta- 
tive norm for the students at the Institute. The wide varia- 
tions from this norm, shown in records of individual stu- 
dents, indicate that subjective factors must have had an im- 



152 TRAINING IN PSYCHIATRIC SOCIAL WORK 

portant effect on volume of work. It was thought that the 
experience of a few individual students might throw light on 
the subjective factors involved and the supervisors' reports 
on six students have been studied with this in view. 

The six students whose experience is here briefly sum- 
marized were all rated by their supervisors as below average 
in the first quarter of their training. Three continued to make 
an adaptation which was considered somewhat below average, 
while the other three made sufficient progress to cause their 
supervisors to classify them in the average or above average 
groups in the second and third quarters of their training. 1 
These students were not selected because they were outstand- 
ing in any way from other students rating as below average 
in the first quarter. They varied among themselves in diffi- 
culties in adjustment to the training situation as is indicated 
by their records in succeeding quarters, but they were uni- 
form in one respect, namely, that in the beginning they all 
showed evidence of being emotionally handicapped in inte- 
grating theory with practice. On this basis, it was thought of 
interest to discover from a survey of their records whether 
the emotional factors influencing the quality of their work at 
the beginning of training might be reflected in the volume of 
work carried by them at this time and also, as these emotional 
difficulties persisted or tended to resolve during training, 
whether there was a corresponding persistence or change in 
the volume of work. 

The three students who remained in the below average 
classification throughout the three quarters of their training 
represent one of the most difficult of all training problems: 
namely, the extent of responsibility that should be assumed 
by the training agency toward apparently unpromising mate- 

i See chapter vi, page 135, for discussion of first quarter ratings in relation to those 
of later quarters. 



EXAMPLES OF TRAINING EXPERIENCE 153 

rial. Should the inadequacies of these students have been 
considered sufficiently great at some point before the end of 
three quarters of training to justify dropping them from the 
training program in the agency? If we assume for the moment 
that this is true, when should this decision have been made, 
and what further responsibility should the agency, or the 
school, have assumed for steering them out of case work alto- 
gether, or into some other type of social work for which they 
seemed better equipped? It is probable that any supervisor or 
executive with a substantial background of case work experi- 
ence would agree that these are problems about which one 
cannot generalize, and that each situation must be dealt with 
on an individual basis. On these terms, then, presumably 
there might on occasion be reasons for permitting certain stu- 
dents of apparently below average qualifications for psychiat- 
ric social work to remain for the full span of agency training 
as originally planned. This might be true, for example, of 
students whose maladjustment seemed to be definitely of a 
temporary nature, perhaps largely attributable to the train- 
ing situation itself, with a fair prognosis for gradual resolu- 
tion on the job , or again it might be true of students whose 
maladjustment appeared more deep-rooted, indicating need 
for psychiatric help, of which they were themselves aware 
and for which they were ready to make provision. 

The volume of work carried by the six students in the first 
quarter did not deviate significantly from the average vol- 
ume of work carried in the first quarter by the Special Study 
Group. As rated by the student-supervisor chart, however, 
they were uniformly considered immature in their thinking 
during this period. All but one had outstanding emotional 
difficulty in acceptance of supervision} four showed emo- 
tional blocking in the acceptance of subject matter and of 
social psychiatric concepts, and in the practical application of 



154 TRAINING IN PSYCHIATRIC SOCIAL WORK 

such concepts to case situations. Three showed outstanding 
inadequacies in the timidity-authority range in approach to 
case situations. 2 Four were deficient in ability to carry cases on 
an intensive level, even when judged by the minimum stand- 
ards set in the first quarter. On the whole, then, they re- 
vealed a marked inability to maintain an openminded, ob- 
jective attitude toward the newer concepts and practices 
involved in the training situation. This was shown particu- 
larly in their poor adjustment to the demands of an unfamil- 
iar and exacting clinic situation, and in their emotional re- 
sponses to the challenge which newer concepts offered to 
formulations resulting from their earlier training. During 
the second and third quarters, the progress of these students 
shows an interesting variety which can be explained by indi- 
vidual differences in ability to adjust to the training situation. 
The records of the three whose work was average or above in 
the last two quarters, Miss P., Miss M., and Miss E., will be 
discussed first. 

Miss P. 

Miss P. was one of the students who showed considerable 
progress in the second quarter, rating in the average group in 
adjustment to the training situation. Although she had a 
somewhat smaller case load at the end of the second quarter, 
the number of contacts and of cases carried in intensive serv- 
ice was not significantly lower than that of the students in the 
above average group. 

This student was twenty-six years old at the time of enter- 
ing the Institute and was an experienced case worker in the 
field of child placement. In her position in a well known or- 
ganization for child welfare, she had gained considerable se- 

2 See page 105, Item 6, Social approach, for discussion of utilization and meaning 
in this study of the phrase "timidity-authority range.'* 



EXAMPLES OF TRAINING EXPERIENCE 155 

curity and recognition in the agency and the community. Her 
outstanding difficulties in the first quarter were: immaturity 
of thought, resistance to the acceptance of supervision and 
subject matter, subjectivity, failure to grasp and use psychi- 
atric principles, and superficial handling of case work issues. 
Her supervisor reported that "her ability to make a transfer 
from previous professional experiences was not wholly de- 
termined, though there were indications that she was tied to 
her past experience and had not 'gone over' adequately to the 
present situation." 

In the second quarter she showed a decided gain in ability 
to handle her difficulties, with the exception of the tendency 
to identify so closely with certain individuals in her case 
situations, that she was not able to maintain her objectivity. 
The supervisor's report for the quarter goes into considerable 
detail concerning the way in which the student was led to 
work out some of her problems through discussion of con- 
crete case situations, but the range of case assignments in rela- 
tion to her needs is not discussed. In the summary of the 
training plan for the next quarter the statement is made that 
"the student is ready for more pressure" which seems to indi- 
cate that possibly the case load was kept low in this instance 
to allow the student time to work through the emotional dif- 
ficulties which were handicapping her, on the theory that a 
large number of cases would tend to slow up her progress. 

One possible lead to the thinking underlying this decision 
may be found in the supervisor's statement in the report for 
the second quarter, that in regard to one case the student 
postponed contacts a long time, being obviously fearful of 
handling the mother, who was of superior social and eco- 
nomic background, and that in another case the student was 
resistive to making contacts with the older siblings of a pa- 
tient whose parents had separated, and neither of whom was 



156 TRAINING IN PSYCHIATRIC SOCIAL WORK 

available for treatment. A larger case load assignment at this 
time may have been considered unwise because of the oppor- 
tunities it would have afforded the student to scatter her 
treatment contacts and to postpone facing the issues in the 
cases on which she felt emotionally blocked. 

In checking with the supervisor, the explanation of the 
situation given above was substantiated by her recollection. 
In spite of her attempt to lead the student to work through 
her tendency to project responsibility on individuals in au- 
thority, the student, she remembered, continued to show 
overdependence in the second quarter to some extent and to 
rationalize her feeling of inadequacy by saying that others 
could handle the situation better than she, or that at least any 
effort on her part would be destructive. 

This reaction on the part of Miss P. seemed to be condi- 
tioned by a number of factors, among them the extreme in- 
security she was experiencing in a new situation where the 
treatment emphasis was on the relatively intangible issues of 
shifting attitudes rather than on the more concrete aspects of 
investigation and placement, to which she had been accus- 
tomed in the particular children's organization with which 
she had formerly worked. The threat of finding herself in a 
situation where temporarily she was unequipped with the 
tools for doing an adequate job may easily have contributed 
to her tendency to reject, for some time, the total contribu- 
tion of this new field and to fail to keep an openminded atti- 
tude toward the possibilities to be found in it. Each evidence 
of resistance on the student's part was met by the supervisor 
in terms of the individual case situation under discussion, an 
attempt being made, for example, to help her see that in her 
reluctance to make contacts with the older siblings in the case 
referred to above, her own fears and defensive attitude 
might create a like response in the client. It was pointed out 



EXAMPLES OF TRAINING EXPERIENCE 157 

that when a worker attempts to effect a change in another's 
point of view, her own conviction of the value of the rela- 
tionship becomes an important factor in treatment. In this 
instance, the student was quick to grasp the implication intel- 
lectually, but still found it necessary, because of her inse- 
curity, to react emotionally on a subjective level in discussion 
with the supervisor. That she was able to resolve her conflict 
on this point to some extent, however, was evidenced in the 
report of a later contact with the patient's older sister, with 
whom she was successful in starting a good treatment rela- 
tionship. 

Other issues were handled as they arose, in terms of the 
individual case situation under discussion, with the result that 
by the end of the second quarter we find in the supervisor's 
report the following comments: 

Student ... is gradually gaining confidence. . . . Interview 
technique is improving, not only through an acceptance of psychiatric 
principles, but also because of the gain in confidence due to an identi- 
fication with the personnel of the Institute which she formerly 
lacked. There is some capacity for leadership and with the clearing 
of her confusion one would look for considerable growth this next 
quarter. 

In discussing Miss P.'s problems and progress, the super- 
visor, after the lapse of several years, was still inclined to 
feel that her policy of keeping a low case load in this particu- 
lar instance had definitely contributed to the student's prog- 
ress, but that if there had been greater case pressure in the 
agency at the time, it would have been necessary to assign 
more cases and handle the problems arising from this pres- 
sure for the student as best she could. It therefore can be said 
in this instance that the student's program was controlled by 
her own needs only in so far as her needs did not conflict with 
those of the agency. 



158 TRAINING IN PSYCHIATRIC SOCIAL WORK 

In the third quarter, Miss P. continued to show progress in 
her ability to plan and direct treatment in accordance with 
the social psychiatric principles which she no longer resisted, 
and which she was definitely assimilating and integrating as 
a part of her own thinking and feeling. Her emotional ac- 
ceptance of supervision in the last quarter of her training was 
relatively complete, and released from her earlier conflicts, 
she became more effective in all aspects of her work, includ- 
ing the carrying of routine. It was felt, however, that since 
the adjustment she was working out was relatively new and 
incompletely established at this point, her potentialities for 
growth in future jobs could not be counted on with as much 
assurance as was the case with some of the other students. On 
this basis, and also because she had not yet developed an 
ability to do effective and consistently discriminating case 
work, her supervisor gave her a final rating of average rather 
than above average. 

In this last quarter Miss P. carried a somewhat smaller 
case load than the average load carried by the students who 
were rated as above average, but in respect to contacts and 
cases carried in intensive service her record of volume of 
work was, as in the first two quarters, comparable to that of 
the above average group. The small case load in the third 
quarter might have been anticipated since, with such a slow 
start, administrative limitations would make it practically im- 
possible for her to supplement her experience in the last 
quarter with enough cases to bring her case load up to the 
average level, even had this been considered desirable. In 
this instance, therefore, it may be said that the student's pro- 
gram was partially adapted to her needs during at least two 
quarters of her training, in that she was not exposed to the 
pressure of a large number of cases, limitations set by mate- 
rial available at the time in the organization being a con- 



EXAMPLES OF TRAINING EXPERIENCE 159 

tributing factor in keeping down the size of the case load; 
but that in other respects the volume of work carried by her 
throughout was on the level of that of other students whose 
adaptation to the training situation had been more easily 
effected from the start. 

Miss M. 

Miss M. was the youngest and least experienced of the 
three students who rated as below average during the first 
quarter only. Shortly after the beginning of the second quar- 
ter, she showed so much improvement in freeing herself 
from overdependence on her supervisor, in initiative and in- 
creasing maturity of thought, in objectivity toward her case 
work, and in handling criticism of herself, as well as in her 
grasp and integration of theory and practice and in organiza- 
tion of her time, that it was felt she was showing evidence of 
ability to become a very adequate psychiatric social worker, 
and her supervisor considered she was actually somewhat 
above average as a worker. 

In the third quarter she continued to show growth in inde- 
pendence and skill in handling case situations, and main- 
tained her position in the above average group. In reviewing 
her work in the last quarter, bearing in mind her lack of pre- 
vious case work experience, her supervisor felt it important 
that she have reenforcement in working out more adequate 
plans of treatment for her cases, based not only on awareness 
of the emotional implications in a situation in which quality 
she rated high but more specifically through emphasis upon 
the ways in which this could be utilized in making her rela- 
tionship with her clients more dynamic and effective. She 
was especially in need of crystallizing the means available to 
her through her own case work techniques in the meeting of 
case issues in which she should assume an active rather than a 



I6O TRAINING IN PSYCHIATRIC SOCIAL WORK 

passive role when this was indicated. The organization of the 
time she had to give to necessary routine, while good, could 
have been improved, and her tempo was not sufficiently ac- 
celerated to rate as superior. Her knowledge of social re- 
sources and utilization of them in a case work plan was aver- 
age, and record writing still showed room for improvement. 
The volume of work carried by her throughout the three 
quarters measured in terms of size of case load, number of 
contacts, and cases carried in intensive service approximated 
the average of the most adequate group of students. 

Miss E. 

Miss E., the third student who made considerable progress 
after the first quarter, showed abilities commensurate with 
the average student in the second quarter. As in the case of 
Miss P. and Miss M., the greatest evidence of improvement 
was in her attitude toward her work, rather than in the vol- 
ume handled. As a matter of fact, in volume of work even in 
the first quarter she ranked with students of good ability. 
However, the immaturity she showed in thinking, her out- 
standing inability to maintain an objective attitude toward 
her cases or her own problems, and her resistance to supervi- 
sion and to the subject matter of psychiatric case work oper- 
ated to make her ineffective and "spotty" in her handling of 
case work issues. She was an experienced student, twenty-nine 
years old, who had had five or six years of case work and 
executive work in social agencies before coming to the Insti- 
tute. 

In the second quarter, Miss E. carried two more cases 
than the average assignment for the most adequate students 
and the amount of intensive work, both pre-staff and post- 
staff, done by her was equivalent to that of this group. Her 
total number of contacts, however, was somewhat less than 



EXAMPLES OF TRAINING EXPERIENCE l6l 

those made by the majority of above average students. Her 
supervisor's report for the quarter discusses her tendency to 
neglect making contacts on cases in which she was not inter- 
ested, but comments on her definite improvement in attitude 
on all the other points which had proven most handicapping 
in her first quarter, such as a tendency to be dependent in her 
thinking, failure in objectivity, etc. As a result of this, the 
supervisor reported that she "makes better independent plans 
than formerly and organizes her time somewhat better. The 
reports of visits have contained more significant material on 
emotional attitudes. She is more conscious of techniques in 
interviewing and weighs more carefully the effect of treat- 
ment on her clients." 

In the third quarter, Miss E. continued to show progress, 
both in handling her own problems and those of her clients, 
and was thought by the supervisor at this time to be proving 
herself to have somewhat more than average ability. The 
points of improvement chiefly stressed by the supervisor 
were her growing independence, better organization of work, 
closer attention to detail, and consistent carrying through of 
plans. One of her greatest assets throughout, even when she 
was going through the period of emotional upset in the ear- 
lier part of her training, had been a certain buoyancy and en- 
thusiasm in superficial contacts which it was felt could be uti- 
lized to great advantage in an organization where selling a 
mental hygiene program in a community was an important 
part of the job. She had now accepted and assimilated the so- 
cial psychiatric concepts which had caused her conflict at the 
start, and there seemed no reason to doubt that she was in a 
position to interpret them with understanding and conviction 
to others. While she was not outstanding in her qualifications 
for carrying cases on an intensive level, she did carry a few 
cases very successfully on this basis in her second and third 



l62 TRAINING IN PSYCHIATRIC SOCIAL WORK 

quarter. Her output of work in the third quarter as statisti- 
cally recorded was higher than that of the above average stu- 
dents among whom she now rated, on the majority of counts. 

In the case of a student who presented in the first quarter 
as many problems as Miss E., it might have been supposed 
that an attempt would be made to individualize her program 
more completely than for the ordinary student. In tracing 
her work through three quarters, however, it was evident 
from the records that in general terms of size and distribu- 
tion of case load, numbers of examinations on new cases, and 
old cases carried in intensive treatment, there was no notable 
deviation from the usual assignments made to the most stable 
group of students. In scanning the supervisor's report, there 
is reference to the assignment of several treatment cases with 
outstanding family problems on the basis of the student's 
previous interests in this field. Since, however, this procedure 
of attempting to follow up a student's previous case work ex- 
perience with first assignments containing some similar ele- 
ments was frequently utilized, unless there were contra- 
indications as to the value of this or unless such case material 
was not available, this does not have the significance that 
might otherwise accrue to it. 

The only other reference to selection of cases is an assign- 
ment to this worker, used to handling a larger proportion of 
more quickly remediable situations, of a follow-up in the 
second quarter. This was done in order to give Miss E. an 
opportunity to do a brief specific job and thereby to gain that 
feeling of ready accomplishment which could not be obtained 
from work on cases where results were delayed and often 
unsatisfactory. It is possible, however, in order to approxi- 
mate as closely as possible a well rounded type of experience 
for the student, that there was more selectivity in the assign- 
ment of cases than is anywhere recorded. Such selectivity 



EXAMPLES OF TRAINING EXPERIENCE 163 

would necessarily be limited by the case material available, 
by emergency situations which had to be met and which 
sometimes provided a valuable challenge to the student re- 
luctant to attempt them, and by the needs and limitations of 
other students working under the direction of the same su- 
pervisor. 

Miss T., Miss S., and Miss R. were the three students in 
the group under discussion the quality of whose work was be- 
low average during all three quarters. Two of them, Miss T. 
and Miss S., carried a greater volume of work than the above 
average students throughout the training period} Miss R.'s 
output was low. 

Miss T. 

Miss T. was thirty-three years old at the time she entered 
the Institute. She was an experienced case worker who had 
been in the field of social work practically from the time she 
left college, and had held positions of responsibility in sev- 
eral large communities. Her difficulty in accepting the stu- 
dent role was marked from the start, the problem of finding 
herself deprived of the ego satisfactions of an executive job 
on a good salary being greatly complicated by the need to 
measure up to exacting standards of case work in an organiza- 
tion with whose methods and policies she was unfamiliar. In 
her effort to adjust to this situation, the student became upset 
and confused, her instability showing itself in relation to her 
supervisor, toward whom she was overdependent and reject- 
ing by turns, and toward her case work. She showed slight 
ability either to assume responsibility or to carry on with any 
substantial understanding of the issues involved or the means 
by which they could be met. She worked spasmodically rather 
than at an even tempo, and altogether presented the picture 



164 TRAINING IN PSYCHIATRIC SOCIAL WORK 

of a considerably disorganized individual, whose assets of 
obviously superior intelligence and keen sensitivity to the 
feeling of her clients were not being constructively utilized 
during her first quarter of training. Under these circum- 
stances it may well have been a need to remain identified with 
the previous job which, at least in retrospect, must have 
seemed like a haven of security to her, that made her recon- 
struct to some degree the conditions of pressure she had ex- 
perienced there, and so to hurry about, making large num- 
bers of contacts. While she showed a slight improvement in 
the succeeding two quarters, chiefly in her grasp and use of 
psychiatric principles, in her sense of responsibility toward 
her cases, and in evenness of tempo in her work, she did not 
arrive at a real objectivity in her case work or an acceptance 
of supervision and of her place in the agency during her en- 
tire training period. Her relatively high output of work may 
then very possibly have been conditioned throughout by her 
tie-up to her previous job. It is, perhaps, of real interest in 
the light of this example, once again to remind ourselves of 
how little correlation there may be between the "lo, I am 
busy" reports which a student piles up for herself, and the 
estimate which her supervisor and others in the clinical set-up 
make of her accomplishment in terms of progress in effective 
case treatment. 

Miss S. 

Miss S. was the other student of the so-called below aver- 
age group who maintained a high volume of work through- 
out the three quarters of her training. Her training experi- 
ence is similar in some respects to that of Miss T. Though 
four or five years younger than Miss T. on entering the In- 
stitute, she rated among the most experienced group of stu- 
dents. She was considered very good material in the special- 



EXAMPLES OF TRAINING EXPERIENCE 165 

ized field from which she came, and was personally very 
much identified with this field. She found it difficult to make 
the transfer to another type of case work and to accept the 
concepts and philosophy of evaluation of human behavior in- 
herent in the mental hygiene approach. In supervisory con- 
ferences she frequently referred to the greater exactness and 
more "scientific" methods used in her former work, and was 
insistent on getting all the evidence possible to corroborate 
statements of her clients, in her obvious need to carry out her 
old patterns of investigatory processes. The contacts she 
made in order to obtain data for social examinations, for ex- 
ample, were multiplied beyond the most extravagant records 
formerly set in the agency, and her treatment contacts were 
hardly less prolific, revealing her tendency to uncover masses 
of inessential detail in relation to her clients' attitudes and 
activities and to deal with a great many unimportant minor 
concrete issues. 

In one essential point this student differed markedly from 
Miss T. She was not scattering or spasmodic in her effort. 
Her work was excellently planned with a view to carrying 
out her own objectives, unrelated as these were to those of 
the agency 5 and she accomplished a great volume of work 
with an executiveness and dispatch which might well be the 
envy of many a worker better qualified to do intensive psy- 
chiatric social work. Her attitude and methods underwent 
very little apparent change during the three quarters of her 
training, in spite of a very real intellectual effort on her part 
to accept and identify with the mental hygiene viewpoint. In 
this case one might say that her outstandingly high output 
was actually an index of excellent work habits as well as the 
result of a need to prove herself effective in the more con- 
crete social manipulative details of work when greatly threat- 
ened by her lack of ability to grasp and utilize social psychiat- 



l66 TRAINING IN PSYCHIATRIC SOCIAL WORK 

ric concepts and methods. As long, however, as this quality 
was not combined with others of major importance in deal- 
ing understandingly with human behavior, it was no indica- 
tion of the student's capacities for psychiatric social work. 

MissR. 

Miss R., the one student of the three in the below average 
group whose volume of work through three quarters was 
consistently lower than that of the above average students, 
was probably slowed up in the first quarter by the necessity 
for a minor operation. Although her absence of a week was 
not itself very considerable, some allowance for lowered vi- 
tality for a longer period should perhaps be made. The fact, 
however, that her output in the succeeding two quarters was 
also outstandingly low, suggests that too much emphasis need 
not be placed on illness as a factor in the situation. 

Miss R. was twenty-six years old at the time of entering 
the Institute, and had had four years of consistent case work 
experience in one specialized field, in organizations of recog- 
nizedly high standards. She therefore, like Miss T. and Miss 
S., rated among the most experienced students. She was obvi- 
ously overwhelmed at the start by the readjustment entailed 
in coming into an agency where there was much less pressure 
and a greater emphasis on intensive service than she was accus- 
tomed to. Instead, however, of reacting to this by attempting 
to recreate her former patterns and to attain some sense of 
security and accomplishment from a large volume of work, 
she showed a tendency to shrink from exposing herself to 
criticism on her case work methods and postponed making 
any contacts until the last moment possible. She showed great 
dependence on her supervisor, and her failure to show any 
substantial grasp of the principles of psychiatric social work 
in her first quarter appeared to arise primarily from the emo- 



EXAMPLES OF TRAINING EXPERIENCE 167 

tional blocking resulting from her own sense of inadequacy 
rather than from any tendency to reject the concepts of the 
mental hygiene approach. In the second and third quarters 
she showed some improvement on both of the above points, 
as well as a gradual growth in assurance in handling emo- 
tional issues as they arose in her case work. There was, 
however, very little fundamental change in her attitudes 
throughout the training period, and in this instance, there- 
fore, as in the case of Miss T. and Miss S., we seem to have 
a significant correlation between quantitative output and 
ability. In other words, the emotional blocking which pre- 
vented this student from thoroughly assimilating mental hy- 
giene theory and integrating this in her practice, hampered 
her output to such an extent that this one factor might be 
considered a danger signal. 

In the study of these individual examples of student ex- 
perience some of the emotional factors influencing volume of 
work have become evident. In certain instances these factors 
operated to diminish the volume of work carried, as with 
Miss R. and to a less extent with Miss P. In others, volume 
of work was increased by these factors, as with Miss T. and 
Miss S. In the case of Miss M. volume seemed unaffected by 
her emotional problems. It remained about average through- 
out the training period though there was noticeable improve- 
ment in adjustment. The increase in volume of work carried 
by Miss E. corresponded to her progressive adjustment to 
the training situation. While, then, it appears that only 
through the study of the individual student's experience is it 
possible to detect the factors underlying variations in volume 
of work, it obviously may not be assumed that difficulties in 
adjusting to training will handicap a student in carrying an 
average amount of work; or that difficulties in making a prac- 



l68 TRAINING IN PSYCHIATRIC SOCIAL WORK 

tical application of case work theory will affect the volume of 
work carried by any two students in the same way. 

Clearly, then, volume of work cannot be considered a re- 
liable index of a student's progress in the training experience 
and should be accepted with reservations, and even then only 
in relation to a careful analysis, as a measure of her capacity 
for doing good psychiatric social case work in future jobs. 
Probably only a marked inability to carry an average amount 
of work should be considered a significant liability in the case 
of an otherwise well qualified student. In so far, however, as 
the record of a student's output may in certain instances show 
symptomatic evidence of the causative factors underlying her 
difficulties in adjustment, it may prove of help to the super- 
visor in clarifying for herself the student's problems. 

In recapitulation it may be said that the analysis of volume 
of work contained in this study was made with the con- 
viction, not that it is in itself of intrinsic importance, but that 
it has a value in throwing light on areas in our thinking con- 
cerning case work philosophy and policy and training prob- 
lems which habitually need stimulation and clarification from 
every one of the sources available to us. 



APPENDIX 

ADJUSTED AVERAGES OF THE NEW YORK 
SCHOOL SPECIAL STUDY GROUP 



As EXPLAINED in Chapter VI, the Special Study Groups were made 
up of certain students who had been in training for the years 1928 
1932. Even though the group from each school during this period 
was small, the experiment was first tried of subdividing it into two 
two-year groups, as follows: 



Smith College School students 

October, 1928 June, 1930 25 

October, 1930 June, 1932 32 

Total 57 

New York School students 

October, 1928 June, 1930 15 

October, 1930 June, 1932 9 

Total 24 



This procedure was followed in order to ascertain if some of the 
changing emphases in student training through these years were suf- 
ficiently marked to effect significant differences in the figures on 
case load and contacts. It was found that for the Smith College 
School students no such significant differences existed, average num- 
bers of cases carried and of contacts being relatively the same dur- 
ing the two two-year periods. For the New York School students, 
the average number of cases was greater in the second two-year 
period than in the first, equaling the average for the Smith College 
School students, although the averages on case contacts remained 
approximately the same during the two periods. The figures for 



I7O TRAINING IN PSYCHIATRIC SOCIAL WORK 

average number of cases carried by the New York School students 
ran as follows: 

First quarter Second quarter Third quarter 

1928-1930 6 II 13 

1930-1932 10 15 18 

It was decided that it would be of more value, however, in the 
statistical analysis of volume and quality of work, to use figures for 
the entire period 19281932 rather than to confuse the issues by dis- 
cussing not only groups of students from two schools, but subdivi- 
sions within these groups according to arbitrarily determined time 
periods. There were only nine students in the New York School Spe- 
cial Study Group, in the years 1930-1932. Since it was recognized 
that the smaller group in 19301932 was more representative of the 
results of the mature training philosophy of the Institute than the 
group of 15 in 19281930, it was decided to double weight the 
averages of cases and of contacts for the 19301932 group and to 
add in the averages for the 1928-1930 group, the final averages be- 
ing arrived at by dividing the total figures thus obtained by three. 
These averages, then, may be regarded as "adjusted averages" al- 
though for purposes of simplification for the reader, they will be 
referred to in the text as "averages" only, in the same way that ref- 
erence will be made to "averages" taken from the figures of the 
total group of Smith College School students for the 19281932 
period. The reader should bear in mind the fact that the adjusted 
averages for the New York School students represent a standard for 
case load that is somewhat less than the actual standard set by the 
New York School students in the years 1930-1932, although some- 
what higher than that set by the New York School students in the 
years 1928-1930, and that this is to be recognized as only a device 
for showing an approximate trend in student work during these 
years, which cannot be interpreted too literally as representative of 
an actual situation. Corresponding to the double weighting of the 
19301932 volume of work figures in obtaining averages, the nine 
students in the second period were given double weight in distribu- 
tion tables, thus giving 33 as the number of students in the "adjusted 
group" which in the text is referred to as the Special Study Group. 



INDEX 



Abilities of students, terms used in 

evaluating, 102113 
Adler, Herman M., i 
Advice service, 18, 43 
Age: 

as a factor in the selection of stu- 
dents, 21-23 
distribution of students by, 118, 

120122, 123 

related to experience, 122123 
related to quality of work, 22-23, 

115-116, 135-138 
related to supervision, 93 
related to volume of work, 128- 

135 

Agencies : 

cases referred by, 44 
clinic's relationship to, 1920, 68 
students' relationship to, 20, 5051, 
68-69, no 

Allen, Frederick H., 7-8 

Applications, 1718, 52 
number of, 43, 44 
source of, 20, 21, 44, 51 
time spent in taking, 37, 38 
value to students of taking, 52 

"Authority" : 

students' need for, 73-74, 93-95 
students' resistance to, 74-75, 91 

93 

Awareness, defined, 105 

Bureau of Children's Guidance, 2-3, 4 

Campbell, C. Macfie, i 

Case analysis, training value of, 84- 

86 
Case closing, factors influencing, 40- 

4i 
Case contacts: 

average number of, 129-132 
factors influencing number of, 126- 

127 



Case contacts (cont.) : 

number made, by individual stu- 
dents, 143145 
See also Interviewing 
Case intake, factors influencing, 40 
Case load: 

analysis of typical, 43-44 
average, 30-31, 46-4?) **9> *3* 
carried by individual students, 143 

146 
factors influencing, 39, 40, 124 

126 
related to training needs, 4041, 

44-45, 86 

variations in, 46-47, 134-135 
See also Volume of work 
Case material, use of, in training, 48- 

55, 82, 86-87, 9> 97-98 
Case recording, 3435, 3638, in 
Case records, reading of: 
time spent on, 37, 38 
training value of, 98 
Case work: 

approach, 17, 47 

character of, in early training pe- 
riod, 47 

conference, 32, 33, 67-68 
level of, 19, 47, 113 
personal value of, to students, 54- 

55 
philosophy and techniques, 46, 66- 

67, 81-82 
related to student turnover, 26, 65 

66 

Case work experience. See Experience 
Cases: 

acceptance of, 17-18, 41-42 
assignment of, 17, 43, 44~47> 5i- 

55, 82 

closed, defined, 44 
new, average number carried, 129, 

132 
new, defined, 44 



TRAINING IN PSYCHIATRIC SOCIAL WORK 



172 

Cases (cont.) : 

new, training value of, 50, 87, 97 
old, attitude of student toward, 48- 

49 
old, average number carried, 129, 

132 

old, defined, 44 

old, training value of, 48-50, 97 
referred by agencies, 44 
referred by parents, 20, 44 
referred by private physicians, 21, 

44 

referred by public schools, 44, 51 
types of, defined, 43-44 
variety in cases assigned, training 

value of, 45, 5*-55 
See also Client 
A Changing Psychology in Social 

Case Work, 67, 80-81 
Child guidance, changes in concepts 

of, 41 1 
Child guidance clinics: 

as early training centers, 2-3, 45 

development of, 24 

development of psychiatric social 

work in, 3-11 
five year demonstration program, 

2-3 

in Boston, 3 
in Chicago, 3 
organization of, 6, 9, 10 
team work relationship in, 6 
Clark, Mary Augusta, 147 
Class work related to field work, 23- 

*5 
Client: 

relationship to, 511, 41, 47, 53- 
55, 6263, 66-67, 8182, 87, 
88, 92-93, 95, 105, 106, 107, 
no i ii 
See also Cases 
Clinic organization: 

at Institute for Child Guidance, 4, 

1 2-1 8 

related to volume of work, 3038 
Commonwealth Fund, 2, 3, 4, 24 



Conferences : 

attendance at, 3134, 37, 38, 69 
See also Group conferences} Infor- 
mal conferences j Supervisory 
conference 

Conference, one-day diagnostic con- 
sultation, 32, 68-69 

Consultation service, 18 

Consultation service, one-day diag- 
nostic, 20, 50, 68 

Cooperative service, 19-20 

Criticisms by students, 48-49, 56-57, 
76-77, 87 

Dependency of students, 73-74? 93~ 

95 

Diagnostic consultation conference, 
one-day, 32, 6869 

Diagnostic consultation service, one- 
day, 20, 50, 68 

The Dynamics of Child Guidance y 41 

Emotional acceptance of subject mat- 
ter, 46, 5960, 84, 88-89, 9 1 "" 
92, 96 

defined, 105 

Emotional acceptance of supervision, 
59-60, 73-82, 87, 91-92 

defined, 105 
Emotional difficulties of students: 

dependency, 73-74, 84-85, 89, 93- 
95 

in six selected cases, 151-168 

need for "authority" and punish- 
ment, 75-76, 89 

related to experience, 90-96 

related to quality and volume of 
work, 151168 

resistance to "authority," 74 75, 
91-93 

supervisor's approach to, 77-80, 
89-90 

therapeutic approach to, xi-xii, 78 
Emotional difficulties of supervisors, 
76-77 



INDEX 



173 



Evaluation of students' work. See 

Quality of work 
Experience : 

as a factor in the selection of stu- 
dents, 21-23 

distribution of students by, 118, 
119, 122, 123, 136 

groupings by, 118 

related to age, 122-123 

related to emotional difficulties, 90- 
96 

related to quality of work, 22-23, 
ii5> 135-138 

related to supervision, 9096 

related to volume of work, 115- 
116, 128135 

Fellows in psychiatry, x, 14, 16, 56- 

57 

Fellows in psychology, x, 14-15, 16 
Field work: 

related to class work, 23-25 
variation in schedule, 27-28, 116, 
117 

Generic case work, 23, 29-30 
Glueck, Bernard, i, 2 
Group conferences, 3233 

time spent in attendance at, 37, 38 
training value of, 59-60, 88 
See also Case work conference* 
Initial conference j Diagnostic 
consultation conference, one-day j 
Treatment conference 

Healy, William, i, 3 

Informal conferences, 32-33 
Initial conference, 32, 55, 60-64 
Initial interviews, 17 
Institute for Child Guidance: 

clinic organization, 4 12-18 

established, 4 

fellows in training, x, 14-16, 56- 
57 



Institute for Child Guidance (cont.) : 

functions, ix, 4 

staff, 1213 

staff, functions other than training, 
17-18 

staff, training functions, 1516 

team work relationship, 1617 
Institute for Child Guidance, xi, 43 
Institute for Juvenile Research, 3 
Intellectual capacity, defined, 102 
Intensive level of case work, 19, 47, 

113 

Intensive service. See Post-staff inten- 
sive treatment j Pre-staff intensive 
service j Treatment service 
Interviewing: 

technique of, defined, no 

time spent in, 36, 37, 38 

See also Case contacts 
Interviews, initial and referral, 17 

Jarrett, Mary C., 2 

Judge Baker Foundation. See Judge 
Baker Guidance Center 

Judge Baker Guidance Center, 3 

Judgment and discrimination, defined, 
104 

Juvenile Psychopathic Institute, Chi- 
cago. See Institute for Juvenile 
Research 

Ken worthy, Marion E., i, 2, 6-7, 41, 
105 

Leadership, defined, 107 

Lee, Porter R., 105 

Levy, David M., i 

Lowrey, Lawson G., ix xii, i, 43 

Maturity of thought, defined, 103 
Meetings. See Conferences 
Mental Hygiene and Social Work, 
105, 106 



TRAINING IN PSYCHIATRIC SOCIAL WORK 



Mental hygiene courses: 

at schools of social work, 2, 3, 23 

*5 
Meyer, Adolf, 2 



National Committee for Mental Hy- 

giene, 3 

The New Social Philosophy, 7 
New York School of Social Work: 
adjustment of training program to 

the needs of , 1 6 
development of training for psy- 

chiatric social work at, 23 
number of students from, 2526 
number of students from, in Spe- 

cial Study Group, 118, 169-170 
reports on students from, 99 
selection of students from, 2 1 
students from, compared with those 

from Smith College School for 

Social Work, 114123, 128-137, 

141-145 
time schedule of students from, 27- 

28, 35-3<5, 38, 116-117 
training plan of, 2325 

Objectivity. See Subjectivity-objec- 

tivity, defined 
Organization sense, defined, 108 

Parents : 

cases referred by, 20, 44 

cooperation of, 41, 48 
Pediatrician : 

in team work relationship, 4, 17 

on staff, 13 
Physical condition in relation to stu- 

dent work, defined, 107 
Physicians, cases referred by, 21, 44 
Planfulness, defined, 108 
Post-staff intensive treatment: 

average number of cases carried, 
129, 131 

defined, 130 



Pre-staff intensive service: 

average number of cases carried, 
129, 131 

defined, 127 

Psychiatric concepts, grasp and use 
of, by students, 46, 59-60, 84, 
88-89, 91-92, 96 

defined, 109 

See also Training concepts 
Psychiatric social work, development 
of, 1-2 

in child guidance clinics, 31 1 
Psychiatric social worker: 

in team work relationship, 4, 17 

on staff, 13 

relationship to psychiatrist, 46 
Psychiatrist : 

in team work relationship, 4, 1 7 

on staff, 13 

relationship to psychiatric social 
worker, 46 

relationship to student, 5557 
Psychoanalysis, 910 
Psychologist: 

in team work relationship, 4, 17 

on staff, 13 

Quality of work : 

analysis of, 114, 135-142 
groupings by, defined, 99-101 
methods of evaluating, 98102 
related to age and experience, 22- 

23, 115-116, 135-138 
related to emotional difficulties of 

six students, 151-168 
related to volume of work, 116, 

138-142, 143, 145, 146 
terms used in evaluating, 102-113 
Quarter (unit of time), defined, 24 

Rapport, ability to gain and maintain, 

defined, 107 

Record writing, 347-35, 36-38, in 
Recording of training activities, 3 5-3 8 
value of, 146149 



INDEX 



175 



Recording and Reporting for Child 

Guidance Clinic s y 147 
Referral, sources of: 

agencies, 44 

parents, 20, 44 

physicians, 21, 44 

schools, 44, 51 
Referral committee, 18 
Referral interviews, 17 
Registration, 17 

Relationship. See Agencies 5 Client} 
Psychiatrist j Supervisor j Team 
work relationship 
Reports on students' work, 98-99 
Responsibility, defined, 109 
Responsibility, shared, 17, 39, 55-58 

attitude of students toward, 56-57 

See also Team work relationship 
Robinson, Virginia P., 67, 80-81 

Salmon, Thomas W., 2 
Schools, cases referred by, 44, 51 
Selection of students, 21-23, 114, 150 
Self-criticism, student's ability for, 

34-35 

Sensitivity, defined, 105 
Service : 

advice, 18, 43 

consultation, 18 

consultation, one-day diagnostic, 

20, 50, 68 
cooperative, 19-20 
post-staff intensive treatment, 129, 

130* 131 

pre-staff intensive, 127, 129, 131 
treatment, 1819, 126-127, 129- 

132 

Short-term students, 26, 96-98 
Smith, Geddes, xi, 43 
Smith College School for Social 

Work: 
adjustment of training program to 

the needs of, 16 

assistant director of, as research as- 
sistant, 21 



Smith College School for Social 

Work (cont.) : 

development of training for psy- 
chiatric social work at, 2 
number of students from, 25-26 
number of students from, in Spe- 
cial Study Group, 117-118, 169- 
170 

reports on students from, 99 
selection of students from, 21 
students from, compared with those 
from New York School of Social 
Work, 114-123, 128-137, 141- 

145 
time schedule of students from, 28, 

35-37, 116, 117 
training plan of, 23 
Social approach, defined, 105 
Social examination, summarizing of, 

55, 60-63 

training value of, 63-64 
Social resources, appreciation and 

utilization of, defined, no 
Social Service Exchange, 1 8 
Social service staff conference, 70 
Southard, Elmer E., 2 
Special Study Group: 

analysis of , 116-146, 169-170 
analysis of, statistical significance, 

118, I43~i49 
basis of selection, 116 118 
number of students in, 117-118, 

169170 

Stability, defined, 106 
Staff. See Institute for Child Guid- 
ance 

Staff conference, 33, 70 
Statistical data. See Special Study 
Group j Recording of training 
activities 
Students: 

inadequate, dropping of, 152153 
individual, volume and quality of 

work of six, 152-168 
length of training, 2628, 116117 
number, 25-26 



i 7 6 

Students (cont.) : 

positions held by former, 30 

relationship to psychiatrist, 5557 

selection of, 21-23, 114, 150 

hort-term, 26, 9698 

See also New York School of So- 
cial Workj Smith College School 
for Social Work} Special Study 
Group. For factors in training 
see under specific heads 
Subjectivity-objectivity, defined, 106 
Supervision : 

acceptance of, by students, 59-60, 
73-82, 87, 91-92, 105 

criticisms of, by students, 76-77 

general objectives of, 73, 93 

need for further study of, 71, 80 

related to individual experience of 
student, 8284 

related to philosophy of case work, 
81-82 

related to student's ability for self- 
criticism, 8485 

related to student's acceptance of 
psychiatric concepts, 88-89 

staff discussion of, 7071 

weaknesses in, 7677, 84 

See also Supervisor 
Supervisor : 

approach to emotional difficulties 
of students, 7780, 8990 

approach to inexperienced students, 
9096 

approach to short-term students, 
96-98 

approach to young students, 93 

assignment of students to, 7173 

case work responsibility of, 72 

emotional difficulties of, 76-77 

relationship to students, 70-71, 73- 
82 

reports on students' work, 98-99 

role of, 16, 18, 33, 73 

training methods used by, 4955, 
82-98 

See also Supervision 



TRAINING IN PSYCHIATRIC SOCIAL WORK 



Supervisor-student chart : 

as method for evaluating work, 

99102 
definition of terms used in, 102- 

113 
Supervisory conferences, 31, 33-34 

time spent in attendance at, 37, 38 
Sustained effort, defined, 107 

Team work relationship: 

at Institute for Child Guidance, 17 

defined, 4 

students' adjustment to, 16, 55-57, 

59, 63-64, 87 
Tempo, defined, 112 
Therapeutic approach to emotional 
difficulties of students, xi-xii, 78 
Time, distribution of students': 

by activities, 31-38 

by months and days, 26-28, 116- 

117 

Towle, Charlotte, 102 
Training : 

criteria of progress in, 80, 86 

effect of, on case load, 4041 

length of, 2628, 116117 

methods used by supervisor, 49- 
55, 82-98 

related to vocational aims, 28-30, 

96 
Training concepts: 

changes in, 511 

in early clinics, 45 

related to treatment, 139140 

See also Psychiatric concepts, grasp 

and use of, by students 
Treatment: 

continuity of, 65, 66 

responsibility for, 17, 39, 44, 46, 

55~58 

Treatment concepts: 
changes in, 311 
related to training concepts, 139 

140 
Treatment conference, 32, 6567 



Treatment level, 18-19, 126127, 

1291 32 
Treatment service, 1819 

intensive, 1819, 126127, 129 

132 

Vocational aspects of training, 28 

3Q> 9* 
Volume of work: 

analysis of, 114, 124135, 138 

146 

defined, 112 
related to age and experience, 115 

116, 128-135 
related to clinic organization, 30- 

38 
related to emotional difficulties of 

six students, 151168 



INDEX 177 

Volume of work (cont.) : 

related to needs of the case, 126 

127 
relate^ to quality of work, 116, 

138-142, 143, 145, 146 
related to training situation, 4041, 

124126 

standard for, 149 
standard for, at Institute for Child 

Guidance, 151-152 
variation in, by individual students, 

143-146 

variation in, by quarters, 132 
See also Case load 

Watson, Maude E., 7 
White, William A., 2 
Williams, Frankwood E., 2